African-American physicians in the highly race-conscious turn-of-the-century South were gaining recognition and achieving a measure of success. Like other physicians, they faced the problems of gaining patients’ confidence and establishing relationships with colleagues. But black physicians of the period lived always with another issue that affected their careers and personal lives—race. For example, they had to overcome black patients’ reluctance to use their services, low remuneration from a generally poorer, predominantly black clientele, and an unfriendly reception and professional exclusion from many white physicians.

Most African-American physicians practicing before 1920 had attended one of the dozen missionary or proprietary medical schools established for former slaves after emancipation. Through every phase of their educational career, black medical students were told how much their people needed them, how much they could help advance their race, and how personally rewarding the profession of medicine was. President Charles F. Meserve of Leonard Medical School at Shaw University in Raleigh, NC, explained in his 1906 commencement address: “This institution and others of similar character cannot begin to meet the calls that are coming constantly for trained physicians and pharmacists.”

For the young black doctor, all of this attention meant instant prestige and status in the black community. But instant status did not mean an easy transition from poor medical student to well-heeled professional. African-American doctors often encountered a disparity between the status accorded them as educated leaders in the community and the level of acceptance given them as professional healers. After graduating from medical school, black doctors looked forward to developing a practice and helping their people. Deep within, though, some must have wondered, as did John Edward Perry on his graduation day in Nashville in 1895, “What does the future hold in store?” Most of these students were poor and entered the profession with few material possessions other than some medical books and instruments.

It could be a lonely and trying time. J. Edward Perry recalled years later his feelings shortly after arriving in Mexico, Missouri, in 1895: “There were only three lonely days before a request was made for me to see a [patient]....[That first Sunday] a shadow of gloom hovered over me as I thought of friends, mother and father far away, while I struggled among strangers.” Sometimes the local church provided comfort for lonely black physicians in new towns, and also some needed publicity to help start a practice. Perry, on that first solitary Sunday in Mexico, Missouri, ultimately found warmth and company at the Methodist Church.

Race added an extra measure of uncertainty to the arrival of a black practitioner. Few blacks and even fewer whites had ever met and dealt with, personally or professionally, a black physician. So the same black citizens who accorded black physicians high status in the community also treated warily someone so different from themselves who took on a role usually reserved for whites.

African Americans did not always find it easy to give members of professions of their own race a fair trial. They were distrustful of black physicians after years of relying on white practitioners. Dr. Robert F. Boyd, an 1882 Meharry graduate, reported in 1887 that “very few good [black Nashville] families had ever given colored doctors their practice,” because “they did not believe them competent.” According to Dr. Thaddeus A. Walker, another Meharry graduate, “I started my practice here [Baton Rouge, LA] with considerable opposition from my own people.”

Drumming up business among reluctant black patients was only one difficulty the black doctor faced upon moving to a new town. The mere presence of a black doctor often stirred up racial tensions between blacks and whites. In May 1906, one black woman exclaimed when Joseph E. Walker announced himself as the new doctor in town (Indianola, MS): “My God, what is dis here town coming to—dese white folks just now getting ober habing 'er nigger Postmaster and now here comes 'er nigger Doctor—Did Ros'velt send 'm 'ere too?”

Black patients were not alone in their worries about the effects black doctors might have on local race relations; black physicians had similar concerns. James Martin’s 1920 study of Tennessee physicians found that most white physicians “regarded the negro physician as an economic competitor.” In addition, white doctors in Tennessee could still say frankly to Martin (a white sociologist), “You will find that the negro mind is incapable of any considerable development, and Dr. A., being a colored man, is not to be seriously regarded as a real physician. He is a good negro, but still a negro.” White physicians adhered to these same racist attitudes when they refused to consult with or assist black colleagues in the treatment of patients in extremis. Such refusals endangered the lives of patients and undermined the trust of black patients for black physicians.

Southern white doctors took advantage of black practitioners’ vulnerable positions to isolate them professionally. In addition to refusing to consult with or assist blacks, they barred their black colleagues from joining local and state medical societies, refused them admitting privileges to local hospitals, and overtly and subtly tried to reduce their competitiveness for patients who could afford to pay. This gulf of isolation based on race appeared almost immediately after blacks entered the medical profession in the 1860s. Exclusionary policies adversely affected African- American physicians’ pocketbooks, professional competency, and standing with their patients.

Income was another matter that caused tension between black and white physicians. The entry of African Americans into an already crowded profession often worsened existing racial stress. White practitioners appear generally to have surrendered their nonpaying and indigent black and white patients to the new black doctors without strong protest. But black physicians had to feed their families too, and so at times found themselves competing for pay patients with white physicians.

In general, ailing whites who patronized black physicians came from the poorer classes, but some white paying patients also turned to black physicians for their medical care, thereby confirming the fears of certain white doctors. Evidence indicates that, though black physicians attracted some of their white clientele because of professional reputations, they also won white patronage for two less glamorous reasons. First, perhaps in recognition of the generally low incomes of their patients, or perhaps in order to draw patients to their practices, some black physicians charged less than the usual fees for medical services. The other reason is difficult to document because of its delicacy. Black doctors in the South and elsewhere quietly treated certain white patients for venereal diseases. According to one white Tennessee pharmacist, “When a young fellow of the aristocratic class ... gets syphilis or gonorrhea, he usually goes to this negro [physician] and so avoids the embarrassment of submitting such a case to a friend of the family.” This aspect of Southern black physicians' practice white doctors could not control, as it took place secretly.

Not all relations between white and black physicians were competitive or antagonistic. Some black doctors reported strikingly positive white physician responses to their arrival. Thaddeus A. Walker of Baton Rouge told readers of the Christian Educator in January 1887, “I was given the hand of fellowship by a leading white physician, Dr. J.W. Dupree, who welcomed me with these words: ‘You are my colored medical brother, and I will go with you at any time.’” Robert F. Boyd of Nashville wrote, “All the physicians of the city treat me white.”

Such isolated expressions of good will did not change racist attitudes and practices in Southern society. African-American physicians had to overcome racism among both whites and blacks. They did this by practicing good medicine, by proving themselves competent, by becoming leaders in their communities, and by addressing directly some of the obstacles others put in their paths.

Black physicians fought against professional isolation in several ways. Personal contact with white physicians sometimes helped. More fruitful were activities that sought to circumvent the formal racial isolation imposed by whites. Though these methods simply established parallel segregated institutions for black physicians, they did provide professional opportunities that were otherwise unavailable. Occasionally black physicians in a city established a local medical society and met regularly for professional or social purposes. Others simply recognized common needs and acted to assist one another, even in rural areas.

To deal with the problem of gaining access to hospitals, black practitioners established their own hospitals where they could care for their patients and perform surgery. The pioneering South Carolina physician, Matilda Evans, opened hospitals in Columbia three times between her arrival in 1898, fresh from Women's Medical College in Philadelphia, and 1916. Alonzo McClennan, a Howard graduate, gathered enough black community support to open a hospital and nurse training school in Charleston in 1897. To help spur on isolated Southern black physicians, successful black surgeons like Daniel Hale Williams and George Cleveland Hall, both of Chicago, traveled through the South in the early 20th century, holding surgical clinics for fellow practitioners. These men performed procedures on local patients in order to demonstrate surgical techniques and innovations to blacks barred from or unable to attend postgraduate courses and white hospital clinics. Many African-American physicians tried to link to colleagues on an even broader basis. In 1895, black physicians established the National Medical Association (NMA). By 1920, virtually every southern state had a black medical society that sometimes also included dentists and pharmacists. Miles Vandahurst Lynk of Jackson, Tennessee, published the first black-oriented medical journal, the Medical and Surgical Observer, in 1892. In 1909, the NMA established a second black medical journal, which survives to this day, the Journal of the National Medical Association.

(Note: This article is based on a previous publication, Savitt, T. “Entering a White Profession: Black Physicians in the New South, 1880-1902,” Bulletin of the History of Medicine 1987; 61: 507-40. For complete references, please consult this essay.)