What institution helped convert Civil War Army hospitals into hospitals that served black communities?

Am J Public Health. 2017 May; 107(5): 675–683.

Abstract

In this article, I examine how African American soldiers and veterans experienced and shaped federally sponsored health care during and after World War I. Building on studies of the struggles of Black leaders and health care providers to win professional and public health advancement in the 1920s and 1930s, and of advocates to mobilize for health care rights in the mid-20th century, I focus primarily on the experiences and activism of patients in the interwar years. Private and government correspondence, congressional testimony, and reports from Black newspapers reveal that African American soldiers and veterans communicated directly with policymakers and bureaucrats regarding unequal treatment, assuming roles as “policy actors” who viewed health and medical care as “politics by other means.” In the process, they drew attention to the paradoxes inherent in expanding government entitlements in the era of Jim Crow, and helped shape a veterans’ health system that emerged in the 1920s and remained in place for the following century. They also laid the groundwork for the system’s precedent-setting desegregation, referred to by advocates of the time as “a shining example to the rest of the country.”

“Ward 6 Patients at Camp Mills, NY, June 1918”

Source. Otis Historical Archives 308: Smith Scrapbook, Box 1, Otis Historical Archives, National Museum of Health and Medicine, Silver Spring, MD.

In January 1919, two months after the Armistice of World War I, the Washington Evening Star broke some disturbing news about Walter Reed Army Hospital in Washington, DC, a flagship military facility. Some severely wounded patients were wearing the same unwashed undergarments—wool pants and shirts, or “long johns”—for weeks. Walter Reed’s laundry service washed only hospital-issued cotton pajamas, so patients who wished to wear the warmer wool underwear had limited options: they could send them to be cleaned at their own expense, or do the washing themselves in hospital bathtubs. According to the Star, some simply stopped wearing long johns altogether, and remained only in light pajamas in the dead of the DC winter.1

The Army Inspector General’s Department hastily conducted an investigation, collecting testimony from 45 patients with amputations who had allegedly spoken with the Star.2 Private Samuel Ellis, a Black interviewee whose right arm was amputated, explained that he was wearing pajamas because his long johns had disappeared after he washed them, as he put it, “with my one hand” and left them to dry. “My complaint is . . . got no way to wash my clothes and can’t wring them out with one hand and there is no place to dry them in the ward.”3 Ellis made his dissatisfaction known and demanded better treatment. Eventually, he got it—or, at least, a promise of it. Following the newspaper story and investigation, Walter Reed officials pledged that patients could send their undergarments to be washed at a large training camp in nearby Maryland.4

In this article, I examine how African American soldiers and veterans like Ellis shaped and experienced federally sponsored health care during and after the Great War. Building on studies of the struggles of Black leaders and health care providers to win professional and public health advancement in the 1920s and 1930s, and of health care advocacy efforts in the mid-20th century, I focus primarily on the experiences and activism of patients.5 Private correspondence, congressional testimony, and reports from Black newspapers reveal that African American soldiers and veterans communicated directly with policymakers and bureaucrats regarding unequal treatment, assuming roles as “policy actors” who viewed health and medical care as “politics by other means.”6 In the process, they drew attention to the paradoxes inherent in expanding government entitlements in the era of Jim Crow and helped shape a veterans’ health system that emerged in the 1920s and remained in place for the following century.7 They also laid the groundwork for the system’s pathbreaking desegregation in the 1950s, referred to by advocates of the time as “a shining example to the rest of the country.”8

Historical assessments of health-based interactions between the US government and marginalized groups include stories of tragedy, triumph, and action. Scholars have shown that veterans have won federal entitlements since the nation’s founding, but that African Americans who served typically had to fight access restrictions.9 To be sure, state institutions, agencies, and programs have supported selective neglect and endangered lives, but their practices have also incited calls for change. The exposure of exploitive studies undertaken in the 20th century by the Public Health Service (PHS) and army, for example, led to forceful activism and helped bring about an acceptance of core public health principles, such as the necessity for informed consent.10 The distribution of public funds, too, presented opportunities to counter prevailing injustices; the 1963 Simkins v. Cone ruling dictating that federal funding could not be used in hospitals that allowed segregation propelled advocates’ ongoing fight for the legal desegregation of all health facilities.11

Soldiers and veterans of the World War I era were hardly the first or only group to wage battles against race-based, health-related injustices, but they were in a unique position to strike critical blows at Jim Crow’s fragile façade. They had made physical sacrifices on behalf of their nation and had been legally guaranteed a rare privilege: the right to publicly funded hospital care. Although Black health activists had fought since at least the 1910s for access to federally sponsored, community-based public health services, military and veterans’ hospitals served as powerful, visible focal points of institutionalized inequity. In the postwar years, African American leaders increasingly viewed health facilities, including those serving soldiers and veterans, as primary battlegrounds in a wider struggle to dismantle segregation—one front in a larger battle for civil rights. Along with Black newspapers determined to highlight how “African Americans were being discriminated against by the war machine,” they drew attention to reports of shortfalls in care, mobilizing “senses of entitlement and disillusion” to bring about precedent-setting policy change.12

THIS INSTITUTION OF TORTURE: MILITARY HOSPITALS

As the United States mobilized forces in 1917, policymakers hoped to encourage long-term self-reliance among those who served, in part by offering them access to rehabilitation services in military hospitals.13 Because the United States was, as Secretary of the Treasury William McAdoo put it in 1917, “drafting men and compelling them to make, if necessary, the supreme sacrifice for their country,” the government had “a higher obligation . . . to mitigate the horrors of war. . . .”14 No veterans’ health system existed at the beginning of the war, but legislators passed an updated version of the War Risk Insurance Act in 1917, which laid the legislative groundwork for a wide-ranging system of institutional and outpatient care in the years to come. It stipulated that discharged military personnel of the coming war—a force of more than 4 million—

shall be furnished by the United States such reasonable governmental medical, surgical, and hospital services and with such supplies, including artificial limbs, trusses, and similar appliances, as the director may determine to be useful and reasonably necessary. . . .15

The law contained no further explanation of how such ideals would become a reality; its implementation would be dictated, in part, by service members, veterans, and their advocates, who brought attention to shortfalls of military and government care during and after demobilization.

A few years before McAdoo’s pronouncements, W. E. B. Du Bois was also considering the potential outcomes of war, but in a different respect. African Americans, he argued in 1914, should support the allied war effort as a means of fostering greater racial equality the world over.16 By 1919, Du Bois was dejected. Although African Americans had “fought gladly and to the last drop of blood,” he said, “America . . . gloats in lynching, disenfranchisement, caste, brutality, and devilish insult. . . .”17

The perspectives of Du Bois and McAdoo hinted at the experiences of Black soldiers during and after the war. Many imagined themselves, like White soldiers and veterans, as part of a distinct and honored group by virtue of their service. But that status was consistently undercut in the socially and politically volatile postwar climate.

Organizing health services for soldiers posed a distinct challenge to the US Army’s official policy of racial segregation, which remained in place through World War II. Some army officials argued that integration in hospital wards was necessary, because patients had to be “classified by diseases rather than with reference to other considerations.”18 But White service members and concerned citizens, who were accustomed to segregation in military and civil institutions, balked. James Cunningham, for example, charged that he was “placed among crazy negroes as punishment” at Walter Reed Hospital.19 A San Antonio, Texas, resident complained that, “sick soldiers of both races are mixed indiscriminately in the base hospital at Ft. Sam Houston,” and suggested that, “irrespective of the record the soldiers made on foreign battlefield . . . the Southern Jim Crow law must be upheld.”20 In response to such arguments, Army Surgeon General William Gorgas sent a memo to army hospitals in March 1918, declaring that, “it would be . . . in the best interest of all concerned, to arrange for the care of white and colored patients in separate wards or separate rooms, so far as possible.”21 Well after Gorgas’s communication, practices fluctuated from institution to institution in an “imperfectly segregated” military, but the articulated policy demonstrated the extent to which the army was willing to prioritize the social concerns of White patients and advocates, even if doing so might threaten the well-being of Black patients.22

African Americans perceived hostile conditions as an indication that the government was shirking its obligations. In the fall of 1918, two Black soldiers reported that a fellow African American patient was “unmercifully beaten up . . . because he would not give up his place” in the mess hall line. One of the soldiers who issued the complaint, the newspaper reported, “was so downhearted that he actually shed tears,” disappointed in a “government that cannot protect its own soldiers from the ‘crackers,’ as he phrased it.”23 The Chicago Defender later referred to such complaints as “obvious example(s) of a country’s crime against a race that has always shed its blood that this nation might occupy the exalted place in the world of today which it now does.”24

“The Greatest Daddy of ‘Em All,”

Source. The Come-Back Vol. 1, No. 10 (February 5, 1919), Otis Historical Archives 355: Walter Reed Historical Collection. Otis Historical Archives, National Museum of Health and Medicine, Silver Spring, MD.

Using that rationale, wounded and ill African American soldiers took a stand for better treatment. Among them was Nebraska National Guard Sergeant Greenleaf B. Johnson, who was recovering from a grenade wound to the abdomen at Walter Reed in the months following the war.25 During congressional hearings in October 1919 about allegations of shortfalls in military health care, Johnson told legislators that he had been sent to “Ward B,” a 20-foot-by-20-foot basement room where patients with a variety of ailments—contagious diseases, amputations, wounds—were placed as punishment for disciplinary infractions. He was subjected to such treatment, he believed, because he left the hospital to see his ailing sister, in spite of army officials’ denial of his request for leave. When one legislator questioned whether Johnson realized that his actions would have consequences, the soldier replied, “I weighed it carefully . . . it was a deliberate act.” He maintained that White soldiers, too, were subject to harsh treatment: they had been, as he put it, “pulled out of bed and run up and down the ward when they were not able.” “I do believe if a man is patriotic enough to die for a flag,” he said, “the country ought to guarantee the protection of its laws and protect him against the criminal treatment that is practiced in Walter Reed Hospital.”26 Johnson—like Ellis, who lobbied for laundry service—was part of a larger movement of disabled service members who laid the foundation for an expansive veterans’ health system by arguing that they deserved better than they were getting.

WE DESERVE THE SAME: PUBLICLY SANCTIONED CARE

As soldiers such as Johnson were discharged from military hospitals, the federal government turned to the PHS to provide care.27 In 1917, that agency oversaw 19 hospitals and 119 relief stations, where beneficiaries—mainly traveling merchant seamen—commonly received treatment for tuberculosis, influenza, smallpox, bronchitis, rheumatism, and sexually transmitted infections.28

Overwhelmed by the influx of thousands of service members from military hospitals, PHS Surgeon General Rupert Blue worriedly told federal officials that his organization had filled many of its facilities “to over flowing, by placing beds in hallways, on verandas, and even in tents scattered about the reservations. . . .”29 In the early months of the war, there were 1500 inpatients in PHS hospitals across the country.30 As of February 1920, the number had ballooned to slightly more than 11 800.31 By that point, Congress had authorized the agency to assume control over a variety of facilities—some army hospitals that were to be renovated and other, newly built institutions. In June 1920, the PHS was operating 52 of its own hospitals containing more than 11 000 beds, and contracting with approximately 1900 private, state, and military facilities that offered about 27 000 beds.32 All told, between June 1919 and June 1920, there were about 49 000 admissions of veterans to hospitals throughout the country.33 Most were for long-term illnesses like tuberculosis and “neuropsychiatric” conditions.34

In a hospital system that relied largely on contract institutions, federal officials were disturbed that standards of care across the board were neither uniform nor high, but they proved willing to subject patients of color to the poorest conditions. In February 1921, Walter L. Treadway, chief of the Neuro-Psychiatric Division of the PHS, assessed the Central State Hospital in Nashville, Tennessee. He qualified his general statement that the contracted facility was “not sufficiently equipped or staffed . . . for the treatment of beneficiaries” by suggesting that it could be suitable for the “care of all colored insane residents” in the district provided that “certain principles in respect to personnel” were observed, including the provision of a minimum number of doctors and nurses.35

The hostility to integration evident in military hospitals was mirrored in PHS and federally contracted institutions. In the spring of 1921, a federal committee found that veterans with mental illnesses were segregated within institutions in Mississippi and Louisiana, and housed in separate facilities entirely in Georgia, Alabama, and Texas. A doctor who acted as a government advisor regarding veterans’ health issues referred to one of the largest Georgia institutions for African American patients as “very unsatisfactory.”36 At government-funded facilities where both Black and White patients were treated, tensions escalated. In 1922, a riot erupted at the Edward J. Hines Jr Memorial Hospital in Maywood, Illinois. The episode began, The Chicago Defender reported, when four White ex-soldiers knocked on the door of a room where six Black veterans were gathered. “We’re going to chase you out of here,” one of the White men allegedly declared. “If you were in the South you wouldn’t be in any hospital at all,” said another.37

Discharged Black service members declared that they were disappointed and angered by the conditions, and argued that they were being deprived of earned entitlements. S. H. Cavitt wrote to federal officials from Houston, Texas, reporting that, “the doctors and nurses turn deaf ears to [Black veterans’] pleadings.”38 At Fort McHenry in Baltimore, Maryland, African American patients reported that they were allowed to use the Red Cross reading room only when White patients were eating dinner.39 A group of patients at a PHS hospital in Chicago, Illinois, expressed dismay because, during a field trip to a local theater, they “rode down in an ambulance” while White veterans were escorted in “touring cars and limousines.” The African American veterans wondered: “Haven’t we done as much and do we not deserve the same as the whites?”40

There were limited efforts at the federal level to respond to the violence and dissatisfaction experienced by Black soldiers and veterans. In 1919, the Wilson administration assigned African American lieutenant J. Williams Clifford as the “special representative of the Colored service men.”41 In that capacity, Clifford received telegrams and letters reporting “unjust, discriminating and cruel treatment that is accorded wounded heroes.” When he attempted to organize an investigation of a discriminatory institution—Camp Logan, in Texas—he said his efforts were “held up, it being claimed that such procedure would [lead to] trouble.” Slightly more than a year after he assumed his federal post, Clifford resigned in frustration.42

ROAD TO REVOLUTION: A VETERANS’ HEALTH SYSTEM

It was not only African American veterans who were dissatisfied. In the months following the Armistice, majority White advocacy groups, government bureaucrats, and medical professionals alleged that the general hospital care program for discharged service members was neglectful and disorganized. In 1920, they urgently drew attention to the problem of “divided authority,” and argued for the creation of an independent agency to foster greater coordination. Established in August 1921, the Veterans’ Bureau (VB) grew into a diverse social service organization during the interwar years, administering pension, insurance, and medical care programs through a central office in Washington, DC, as well as state-based regional offices.43

Health care, in some respects, was unique in comparison with other entitlements. Those who favored expanding access could justify their position by focusing not only (or, in some cases, not at all) on prospective benefits for veterans, but also (or instead) on the goal of alleviating a potential public health crisis. In this respect, Thomas Salmon, a mental health expert who was part of a committee that helped plan the first veterans’ hospitals, was particularly worried about Black former service members, mainly because they were not seeking treatment at the same rates as their White counterparts. In southern districts, Salmon reported in 1921, 4.4 White veterans per 1000 entered hospitals with tuberculosis compared with 2.1 per 1000 Black veterans. The difference was even greater in the case of neuropsychiatric disorders: 5.1 of every 1000 Whites were admitted for hospital care, as opposed to 1.5 of every 1000 African Americans.44 “If they did not need hospitalization, that would not make any difference,” Salmon said, referring to Black veterans. “But somewhere [they] are a danger and they are much more liable to be a danger to white than to negro.”45

While Salmon and his colleagues agreed that Black veterans should have access to treatment, they also maintained that facilities should be segregated. They were not only worried about confrontations between patients, but also about the fact that, as one doctor suggested, White veterans “will not work where the negroes are working.” So, in southern hospitals, “all the [White] patients sit on the porch and the negro does the work, which is fine for the negroes but bad for the white patients.” “Treating them in separate institutions,” a PHS official suggested, “is almost a necessity.” Salmon agreed: “I do not think there is any question but that they should be in separate institutions.”46

President Warren G. Harding at Walter Reed Hospital, grasping the hand of Lieut. Robert S. Fletcher, who lost both legs during World War I. Created and published between 1921 and 1923.

Source. Courtesy of the Library of Congress. Available at: http://www.loc.gov/pictures/item/98509427.

Those arguments help explain why an all-Black veterans’ hospital was established in 1924 in Tuskegee, Alabama, and why other veterans’ hospitals adopted the principle of “local control.” The story of the genesis of Tuskegee—including contemporary debates among African American advocates as to whether it constituted a sign of equality or oppression—is recounted elsewhere.47 Here, it is worth pointing out that fewer than one third of African Americans under the care of the VB in 1925—about 500 of 1800 patients—were being treated at the Alabama hospital. The remaining 1000-plus were scattered in other federal and civil institutions.48 Throughout the 1920s and 1930s, they were part of a system that adopted “no definite policy relative to the segregation of races” but “insofar as is feasible followed the custom in effect in the various localities in which hospitals are located.”49 As has historically been the case for other institutions—for example, health facilities supported by the Hill-Burton Act—local control of federally sponsored services initially fostered inequity—then, resistance.50

African Americans’ reports of limited access to care and discriminatory treatment in veterans’ hospitals, which resembled their charges against military and PHS facilities, were again duly reported in the Black press. Thomas Albert White, who was suffering from aftereffects of poison gas and had tuberculosis, was forced to ride a segregated rail car from his Pittsburgh, Pennsylvania, home to a veterans’ hospital in Dawson Springs, Kentucky. Once he arrived, the New York Amsterdam News reported, he was “told that no negro soldiers were allowed there,” then he was sent home, where he was “failing rapidly.” Importantly, when the National Association for the Advancement of Colored People (NAACP) brought White’s case to the attention of the VB, the agency’s medical director was quick to reply: the bureau was arranging for the patient to be hospitalized at a sanitarium in Dayton, Ohio, he said, and was examining the situation.51

“Mary Flaherty Lynch, WWI Resconstruction Aide, with her patients at Ft. McHenry, MD. (photo #2).”

Source. Otis Historical Archives 220.03: Lynch Collection. Otis Historical Archives, National Museum of Health and Medicine, Silver Spring, MD.

Solomon P. Suddeth faced similar barriers. He had lost two fingers as a result of a gunshot wound in France, and been diagnosed with tuberculosis upon returning home. In December 1923, the veteran composed a letter to President Calvin Coolidge’s secretary, Campbell Slemp: “I am a disabled veteran having been wounded overseas and in addition to my wound, I have lost my health otherwise,” he wrote. “My condition compels me to ask that you do what you can for me that I may go in the hospital at once.”52 Slemp found Suddeth’s letter compelling enough to send it on to officials at the VB and request that they “look into the matter.” A month later, Suddeth was admitted to Walter Reed Hospital.53

Henry H. Davis, too, contacted government officials with complaints about his health, but he linked his plight directly to bigotry. He wrote to a congressional committee in 1923 explaining that he had lived in a tent while stationed at a camp in Maryland, and become ill. After being discharged with a clean bill of health, he sought treatment at a public clinic, then a PHS hospital, where doctors diagnosed both pulmonary tuberculosis and hookworm. He reported: “I am now helpless and pining away with the disobility [sic] of T.B. . . . [with] no way to support myself or my family.”54 Davis recounted that a doctor told him that his skin color “[kept] me from being a born citizen of U.S. States of America.” That, he said, equated to a “durt y deal. I do not denie being a black man but I do want to say that the service that I rendered to the flag of the U.S. was just as true and onest as the whitest man the sun ever shined on.” Some day, Davis said, “the negrow haters . . . will want the good will and onest service of the black man again . . . but . . . I don’t think that I will ever bee able to render eny more of my service to the U.S.”55

CONCLUSION

An early history of the veterans’ health system characterized desegregation efforts in the mid-1950s as a “quiet revolution” that took place at the highest levels of the bureaucracy.56 Likewise, a 1955 report about the civil rights efforts of the Dwight D. Eisenhower administration innocuously declared that Harvey Higley, administrator of the Veterans Administration (VA), had recently “instructed the managers” of VA installations to end segregation “as soon as possible.”57

But the so-called “revolution” was hardly “quiet” from the perspective of patients and advocates who forcefully brought attention to inequality during and after World War I. When Black advocacy groups told VA officials in a 1946 meeting that “to accept segregation would be a backward step,” they built on the legacy of individual patients who had aired their grievances in Congress, correspondence with government officials, and Black newspapers.58 Patients’ reports of their experiences also informed efforts of leaders like W. Montague Cobb, chairman of the NAACP’s National Health Committee, who argued in 1953 that any “segregative barrier” in VA hospitals was not only “unsound and unscientific,” but also guaranteed an “excessive economic burden” and that “minority group patients” would receive “the inferior part of whatever care is provided.”59 By 1963, although the VA could hardly claim to administer a colorblind health system, Ebony magazine reported that it was, “government’s most integrated agency.”60

Veteran-patients’ claims during and after World War I help explain why it earned that status—and they illuminate dynamics of health activism and incremental policy change. During and after World War I, African American veteran-patients exhorted federal officials to confront the hypocrisy of calling on individuals to sacrifice for their nation, even while their government deemed them unworthy of the privileges that presumably followed that sacrifice—not to mention the minimum benefits of full citizenship. Their testimonies showcased the complexity of managing the health fallout of war, and how a commitment to Jim Crow undercut the administration and expansion of veterans’ benefits. As Black men, patients such as Thomas Albert White and Solomon Suddeth were members of a stigmatized group. But their status as veterans meant they ostensibly had access to entitlements. They and other African American former service members recognized that, made powerful arguments regarding their rights, and helped sway bureaucrats and federal officials to change policies. Although a new veterans’ health system initially supported, rather than challenged, prevailing practices regarding racial inequality, Black veterans and their supporters leveraged government resources to call those practices into question. Federal health entitlements of the World War I period served as the beginning, not the end, of a path toward social justice.

ACKNOWLEDGMENTS

While writing this article, I was supported by the Florida International University Office of the Provost Humanities Research Initiative.

I presented some of this research at the 2016 annual meeting of the American Association for the History of Medicine, where Susan L. Smith, Vanessa N. Gamble, and audience members offered helpful feedback.

I thank Theodore M. Brown and three anonymous reviewers for their thoughtful comments.

Note. This article was adapted with permission from material to be published in Burdens of War: Creating the United States Veterans Health System (Baltimore, MD: Johns Hopkins University Press; in press).

ENDNOTES

1. Robert D. Palmer, “Inspector General’s Department Investigation as to the Laundering of Clothing by Patients at Walter Reed General Hospital” (January 31, 1919), 1, Office of the Inspector General Correspondence, 1917–1934, Record Group 159, Box 1110, Folder: 12, National Archives and Records Administration, College Park, MD.

2. Ibid., 3–8.

3. Inspector General’s Department, “Testimony of Individuals Taken at Walter Reed General Hospital” (January 30, 1919), 57, Office of the Inspector General Correspondence, 1917–1934, Record Group 159, Box 1110, Folder: 12, National Archives and Records Administration, College Park, MD.

4. Col. Schreiner, undated order in “Exhibit A,” “Inspector General’s Department Investigation as to the Laundering....” (January 31, 1919), 74, Office of the Inspector General Correspondence, 1917–1934, Record Group 159, Box 1110, Folder: 12, National Archives and Records Administration, College Park, MD.

5. In addition to sources cited elsewhere in this article regarding connections between health care and civil rights, see the October 2016 issue of the American Journal of Public Health, which focused on the 1960s health-related activism of the Black Panther Party: American Journal of Public Health 106, no. 10 (2016). On advocacy among professionals and lay leaders, see, for example, Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890–1950, Studies in Health, Illness, and Caregiving (Philadelphia, PA: University of Pennsylvania Press, 1995). For more on rights struggles among health care professionals, see the Appendix, available as a supplement to the online version of this article at http://www.ajph.org.

6. The “policy actors” quote is derived from the title, Patients as Policy Actors, ed. Beatrix Hoffman, Nancy Tomes, Rachel Grob, and Mark Schlesinger (New Brunswick, NJ: Rutgers University Press, 2011). The “politics by other means” quote is from Alondra Nelson, Body and Soul: The Black Panther Party and the Fight against Medical Discrimination (Minneapolis, MN: University of Minnesota Press, 2011), see especially Chapter 1. On health care activism, see Beatrix Hoffman, Health Care for Some: Rights and Rationing in the United States Since 1930 (Chicago, IL: The University of Chicago Press, 2012), especially Chapter 7. For more on health activism, see the Appendix, available as a supplement to the online version of this article at http://www.ajph.org.

7. Jessica L. Adler, Burdens of War: Creating the United States Veterans Health System (Baltimore, MD: Johns Hopkins University Press, in press).

8. “The Old Order Changeth,” Journal of the National Medical Association 46, no. 1 (1954): 66. On the desegregation of veterans’ hospitals, see David Barton Smith, “The Politics of Racial Disparities: Desegregating the Hospitals in Jackson, Mississippi,” Milbank Quarterly 83, no. 2(2005): 247–269. For more on the desegregation of veterans’ hospitals, see the Appendix, available as a supplement to the online version of this article at http://www.ajph.org.

9. On the history of veterans’ benefits, see Theda Skocpol, Protecting Soldiers and Mothers (Cambridge, MA: Belknap Press, 1995); Stephen R. Ortiz, Beyond the Bonus March and G.I. Bill (New York, NY: New York University Press, 2010); Glenn C. Altschuler and Stuart M. Blumin, The G.I. Bill: A New Deal for Veterans (New York, NY: Oxford University Press, 2009). On race, ethnicity, and veterans’ health and benefits, see Larry M. Logue and Peter David Blanck, Race, Ethnicity, and Disability: Veterans and Benefits in Post-Civil War America (Cambridge, England, and New York, NY: Cambridge University Press, 2010). For more on veterans’ benefits, including their relation to race and ethnicity, see the Appendix, available as a supplement to the online version of this article at http://www.ajph.org.

10. See, for example, Vanessa Northington Gamble, “Under the Shadow of Tuskegee: African Americans and Health Care,” American Journal of Public Health 87, no. 11 (1997): 1773–1778. Also, Susan L. Smith, Toxic Exposures: Mustard Gas and the Health Consequences of World War II in the United States (New Brunswick, NJ: Rutgers University Press, 2017); Susan M. Reverby, Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, Studies in Social Medicine (Chapel Hill, NC: University of North Carolina Press, 2000). On federal involvement in providing hospital care for freed slaves, see Jim Downs, Sick From Freedom: African American Illness and Suffering During the Civil War and Reconstruction (New York, NY: Oxford University Press, 2012).

11. David Barton Smith argues that the 1963 Simkins decision, stipulating that Hill-Burton funds could not be used to fund segregated hospitals, helped mobilize support for the passage of the landmark 1964 Civil Rights Act: David Barton Smith, Health Care Divided: Race and Healing a Nation (Ann Arbor, MI: University of Michigan Press, 1999), 98–108. For more on federal funding, civil rights, and health care, see the Appendix, available as a supplement to the online version of this article at http://www.ajph.org.

12. The first quote is from William G. Jordan, Black Newspapers and America’s War for Democracy, 1914–1920 (Chapel Hill, NC: University of North Carolina Press, 2001), 164. The second is from Adrianna Danette Lentz-Smith, Freedom Struggles: African Americans and World War I (Cambridge, MA: Harvard University Press, 2009), 4. For more on African American service members and veterans, see the Appendix, available as a supplement to the online version of this article at http://www.ajph.org.

13. On the roots of the army rehabilitation program in World War I, and gendered notions of disability, see Beth Linker, War’s Waste: Rehabilitation in World War I America (Chicago, IL: University of Chicago Press, 2011).

14. To Amend the Bureau of Insurance Act So as to Insure the Men in the Army and Navy, Hearings before the Committee on Interstate and Foreign Commerce, H.R. 5723, Part 1, 65th Cong., 1st sess. (Washington, DC: Government Printing Office, August 11, 1917), 16.

15. An Act to Amend an Act Entitled “An Act to Authorize the Establishment of a Bureau of War Risk Insurance in the Treasury Department,” Approved September Second, Nineteen Hundred and Fourteen, and for Other Purposes, Public Law 90, H.R. 5723, 40 Stat. 398, 65th Cong., 1st sess. (October 6, 1917): 406.

16. W.E.B. Du Bois, “World War and the Color Line,” Crisis 9, no. 1 (1914): 28–30.

17. W.E.B. Du Bois, “Returning Soldiers,” Crisis 18, no. 1 (1919): 13–14.

18. Cited in Jennifer D. Keene, Doughboys, the Great War, and the Remaking of America (Baltimore, MD: The Johns Hopkins University Press, 2001), 90.

19. C.S. Hamilton, “Inspector General’s Department Report of the Alleged Mistreatment of Private James Cunningham, Company G” (1918), Office of the Inspector General Correspondence, 1917–1934, Record Group 159, Box 1109, Folder 6, National Archives and Records Administration, College Park, MD.

20. “Protest Mixing Soldiers Sick in Army Hospital,” The Chicago Defender, March 6, 1920: 19.

21. Cited in Carol R. Byerly, Good Tuberculosis Men: The Army Medical Department’s Struggle with Tuberculosis (Fort Sam Houston, TX: Office of the Surgeon General, Borden Institute, US Army Medical Department Center and School, 2013).

22. The quote is from Jennifer Keene, Doughboys, the Great War, and the Remaking of America, 85.

23. “Soldiers Unmercifully Clubbed by Southerners at Hospital,” The Chicago Defender, November 2, 1918: 1.

24. “Soldier Complains of Inhuman Treatment,” The Chicago Defender, August 2, 1919: 10.

25. Hearings before Subcommittee No. 2 (Camps) of the Select Committee on Expenditures in the War Department, House of Representatives, 66th Cong., 1st sess (1919): 364.

26. Ibid., 363–364.

27. On the Public Health Service in this period and its activities surrounding soldiers and veterans, see Adler, Burdens of War, Chapter 3.

28. Annual Report of the Surgeon General of the Public Health Service of the United States for the Fiscal Year 1917 (Washington, DC: Government Printing Office, 1917), 309–310, 350–365.

29. “Letter from Surgeon General Rupert Blue to Secretary of the Treasury” (September 17, 1918), Records of the Public Health Service, Correspondence with War Risk Insurance Bureau and Veterans’ Bureau, 1917–1923, Record Group 90, Box 7, NC-34, Entry 23, National Archives and Records Administration, College Park, MD.

30. Hugh S. Cumming, “The Work of the Public Health Service in the Care of Disabled Veterans of the World War,” The Military Surgeon 49, no. 1 (1921): 6.

31. “Report of Referred Cases and Hospital Standings, Medical Division, for the Week Ending Feb. 26, 1920” (1920), Records of the Public Health Service, Correspondence with War Risk Insurance Bureau and Veterans Bureau, 1917–1923, Record Group 90, Box 8, NC-34, Entry 23, National Archives and Records Administration, College Park, MD.

32. Annual Report of the Director of the Bureau of War Risk Insurance for the Fiscal Year Ended June 30, 1920 (Washington, DC: Government Printing Office, 1920), 69–73. On the 1919 passage of Public Law 326, which increased the number of facilities available to the PHS, see Adler, Burdens of War, Chapter 3.

33. Annual Report of the Director of the Bureau of War Risk Insurance for the Fiscal Year Ended June 30, 1920, 74.

34. “Report of Referred Cases and Hospital Standings.”.

35. “Letter from W.L. Treadway, Chief Neuropsychiatric Section, U.S.P.H.S., to Assistant Director in Charge of Medical Division, B.W.R.I. Re. Central State Hospital, Nashville, Tennessee” (February 14, 1921), Records of the Public Health Service, Correspondence with War Risk Insurance Bureau and Veterans’ Bureau, 1917–23, Record Group 90, Box 10, NC-34, Entry 23, Folder: BWRI carbons Jan. 1st to Mar. 31st, 1921, National Archives and Records Administration, College Park, MD.

36. “Report of Conference Held in Offices of Consultants on Hospitalization, May 9, 1921,” 63–66, Records of the Public Buildings Service, Record Group 121, Box 35, Entry 164, National Archives and Records Administration, College Park, MD.

37. J. Blaine Poindexter, “US Probes Hospital Fight: Soldiers Discharged after Riot,” The Chicago Defender, February 11, 1922: 1.

38. “Soldiers Cannot Get Insurance,” Afro-American, April 8, 1921. On letter-writing as activism, see Paul Michael Taillon, “‘All Men Are Entitled to Justice by the Government’: Black Workers, Citizenship, Letter Writing, and the World War I State,” Journal of Social History 48, no. 1(2014): 88–111.

39. “Wounded Men Still at Fort Mchenry,” The Afro-American 30, no. 36 (April 21, 1922): 12.

40. Leroy J. Knox et al., “Lest We Forget,” The Chicago Defender, November 6, 1920: 11.

41. “Reports Prejudice in War Risk Work,” The Chicago Defender, November 6, 1920: 1. On Clifford, see the Appendix, available as a supplement to the online version of this article at http://www.ajph.org.

42. “Reports Prejudice in War Risk Work.”.

43. Adler, Burdens of War, Chapter 4.

44. “Report of Conference Held in Offices of Consultants on Hospitalization, May 9, 1921.” On African Americans’ access to health care in this period, activism surrounding it, and its connection to socioeconomic conditions and health outcomes, see the Appendix, available as a supplement to the online version of this article at http://www.ajph.org.

45. “Report of Conference Held in Offices of Consultants on Hospitalization, May 9, 1921,” 65.

46. Ibid., 63–66.

47. Many who spearheaded efforts at the turn of the century to found new hospitals solely for African Americans viewed all-Black health institutions as potential bastions for professional development and havens of protection from discriminatory treatment. On efforts and debates surrounding the creation of all-Black hospitals, see Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920–1945 (New York, NY: Oxford University Press, 1995), which includes a discussion of Tuskegee (183–186). For more on debates surrounding Tuskegee, and the value of integration versus segregation, see the Appendix, available as a supplement to the online version of this article at http://www.ajph.org.

48. Annual Report of the Director, United States Veterans’ Bureau for the Fiscal Year Ended June 30, 1925 (Washington, DC: Government Printing Office, 1925), 136–139.

49. “Letter From Charles M. Griffith to Medical Director” (January 11, 1933), Records of the Veterans Administration, Record Group 15, Policy and General Administration Files, 1917–1959, Box 100, Entry A1-55, Folder: January 1933, National Archives and Records Administration, Washington, DC.

50. On Hill-Burton, see Endnote 11.

51. “Refuse to Treat Negro Veteran,” New York Amsterdam News, February 18, 1925: 11.

52. “Correspondence Re. Solomon Suddeth” (December 1923), Records of the Veterans Administration, Record Group 15, Old Division Files, General Records of the Medical Division and its predecessors (Group III), 1918–1925, Box 91, Entry 58e, Folder: 223, The President of the United States, 1921–24, National Archives and Records Administration, Washington, DC.

53. Suddeth’s earlier pleas foretold tragedy: about a month after he wrote to Slemp, he died at Walter Reed: “Tennessee Obituaries: Cleveland, Tenn., Solomon Suddith [sic],” The Chicago Defender, February 16, 1924: 6; “Deaths Reported: Solomon P. Suddeth,” The Washington Post, January 24, 1924: 8.

54. “Correspondence Re. Henry H. Davis” (1923), Records of the Veterans Administration, Record Group 15, Old Division Files, General Records of the Medical Division and its predecessors (Group III), 1918–1925, Box 92, Entry 58e, Folder: Sen. Inv. Comm. Dec. 1923, National Archives and Records Administration, Washington, DC.

55. Ibid. For another example of dissatisfaction among Black veteran-patients, see “Jim Crow War Veterans in US Hospital: Citizens Angered over Inhuman Treatment,” The Chicago Defender, March 6, 1926: 2.

56. R.E. Adkins, “Medical Care of Veterans, Printed for the House Committee on Veterans Affairs,” 90th Cong., 1st sess. (Washington, DC: Government Printing Office, April 1967), 248–250.

57. “Report by the Attorney General on the Administration’s Efforts in the Field of Racial Segregation and Discrimination (Cabinet Paper)” (January 26, 1955), DDE’s Papers as President, Cabinet Series Box 4, Cabinet Meeting of January 28, 1955, Dwight D. Eisenhower Presidential Library, Museum, and Boyhood Home, Abilene, Kansas, Washington, DC, https://www.eisenhower.archives.gov/research/online_documents/civil_rights_eisenhower_administration/1955_01_26_Attorney_General_Report.pdf (accessed July 17, 2016)

58. A.C. Terrence, “The Problem of Veterans’ Facilities,” Journal of the National Medical Association 38, no. 1 (1946): 37; Roscoe C. Giles, “Post-War Adjustments in Medicine,” Journal of the National Medical Association 38, no. 4(1946): 124–127.

59. “Progress in Integration in Veterans Hospitals,” Journal of the National Medical Association 45, no. 6 (1953): 437–438. In June of 1953, months before Harvey Higley’s desegregation order, the NAACP released its National Health Program, which aimed, in part, to “eliminate hospital discrimination in the United States”: W. Montague Cobb, “The National Health Program of the N.A.A.C.P.,” Journal of the National Medical Association 45, no. 5(1953): 333.

60. “Government’s Most Integrated Agency,” Ebony, March 1963: 65.

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