The National Negro Health Movement and the Fight to Control Public Health Policy in the African American Community, 1915-1950

ENTHRONING HEALTH: THE NATIONAL NEGRO HEALTH MOVEMENT AND THE FIGHT TO CONTROL PUBLIC HEALTH POLICY IN THE AFRICAN AMERICAN COMMUNITY, 1915-1950

A Dissertation Submitted to the Temple University Graduate Board

In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY

by Paul Alexander Braff Diploma Date December 2020

Examining Committee Members:

Dr. Bettye Collier-Thomas, Advisory Chair, History Dr. Bryant Simon, History Dr. Lila Berman, History Dr. James Downs, External Reader, Gettysburg College

Paul Braff ______All Rights Reserved

iii

ABSTRACT

In the early 1900s, African Americans died at higher rates, got sick more often, and had worse health outcomes for almost all diseases when compared to whites. This disparity was due to a combination of racism, discrimination, and segregation. Most blacks could only afford to live in unhealthy conditions and had little or no access to medical professionals. Problematically, poor black health led many whites to think of blacks as being inherently diseased, promoting the segregation and discrimination that contributed to black ill health in the first place.

This project examines Negro Health Week (NNHW), which became National Negro

Health Week (NNHW), a public health campaign designed by African Americans as a systematic effort to improve their health that lasted between 1915 and 1950. The dissertation reveals the strategies African Americans used to empower themselves to combat ill health and the ways medical ideas became accessible to blacks.

The racism of the white medical establishment limited the ability of African

Americans to enter the medical profession. The small number of black doctors and nurses meant that NHW had to rely on non-medical professionals to teach health practices.

Originally begun as a local campaign in Savannah, Booker T. Washington adopted

Negro Health Week as a program to teach formerly enslaved blacks in Tuskegee,

Alabama how to live.

Working as sharecroppers and living in the small cabins they had inhabited as enslaved people, the majority of blacks lived in squalor. Margaret Murray Washington, who co-founded the National Association of Colored Women in 1896, laid the iv groundwork for NHW at Tuskegee. During her tenure as Lady Principal of Tuskegee, she created the Tuskegee Woman’s Club and brought together local organizations and women’s clubs to work with women in improving their homes by providing advice on basic hygiene and sanitation that they could implement with little cost. Booker T.

Washington coopted the TWC program and brought Monroe Work from Savannah to

Tuskegee to head up a more ambitious program which he envisioned expanding throughout the rural South.

In 1900 Washington founded the National Negro Business League (NNBL) which included key black business men from throughout the nation, especially the South. The

NNBL was instrumental in helping Washington to expand and publicize Negro Health

Week. Under the leadership of Booker T. Washington and his successor, Robert Moton,

NHW continued to focus on providing advice on basic hygiene and sanitation in one’s home and neighborhood. The emphasis on low-cost individual health practices, such as basic privy sanitation or proper whitewash technique, gave African Americans the ability to take ownership of their health. The Week explained how blacks could improve their health and that of the community even without medical professionals.

After Booker T. Washington’s death in 1915, Moton succeeded in getting the support of the national Public Health Service (PHS) and National Negro Health Week came into existence in 1921. The Service’s vast network of health professionals and connections with state and local health departments allowed the campaign to expand out of the South.

However, with the involvement of the PHS, the Week began to change. As hygiene practices became more accepted, the Service reframed NNHW to focus on vaccinations and regular physician and dentist visits. As medical professionals became NNHW v leaders, the campaign’s message transformed from emphasizing how individuals could improve health on their own to describing how much people needed physicians to obtain good health. Under the PHS, lay people could do little to improve their health. Instead, they had to rely on the medical profession. The PHS used NNHW to reposition the medical establishment as the ultimate arbiter of African American health.

Today, there is still a wide racial disparity in participation in, and access to, public health, and indeed in health outcomes in the United States. Understanding the Week can better position scholars and public health officials to understand how race and health intersect and the ramifications of health policies on race relations.

To my parents and to Kaitlyn, Maya, and Elias

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ACKNOWLEDGEMENTS

As a people person, I found the isolation of archival research and writing particularly challenging. I would not have made it to the finish without the support of everyone who pushed me to succeed. The Temple University History Department’s faculty and graduate students encouraged me and were helpful in thinking through and around my work. My research was generously supported by the Consortium for History of Science,

Technology and Medicine, and Temple University’s College of Liberal Arts. A special thank you also goes to the Society for the Social History of Medicine and the National

Science Foundation for supporting travel to several conferences where I presented my work and received valuable feedback. My committee members were kind and hands-off, allowing me to work on my own schedule. I would like to thank my original advisor,

Kenneth Kusmer, for helping guide me through this complicated and at times frustrating process, and Bettye Collier-Thomas for aiding me the rest of the way. James Downs was also instrumental in providing me useful and timely feedback and encouraging me when times seemed bleak. My family has always been there for me and has supported my love of history for as long as I can remember. I will always cherish your positivity and can do spirit, and will seek to instill it in the next generation. To my daughter Maya, who came just within the last two years, thanks for sleeping through the night from an early age.

Dada really appreciates it and it was very helpful. Same thing goes for you too Elias during the final stages of revisions! Finally, my wife Kaitlyn has borne the brunt of my worries, need for complete silence while writing, and long writing days where I would not talk to a soul until she came home in the evening to a tired husband with a great deal viii to say about everything, so excited was he to talk to another human being! Thank you for your love, your support too, but especially your love. I feel so lucky that I get to see you and be with you each and every day.

TABLE OF CONTENTS

Page

ABSTRACT…………………...…………………………………………………...…… iii

DEDICATION..………………………………………………………………………… vi

ACKNOWLEDGMENTS…………………………………………………………....… vii

LIST OF FIGURES…………………………………………………………………....… x

CHAPTER

1. INTRODUCTION ...... 1

2. WHAT DOESN’T KILL YOU DOESN’T NECESSARILY MAKE YOU

STRONGER: THE STATE OF, AND PERCEPTIONS ABOUT, AFRICAN

AMERICAN HEALTH, 1890-1914 ...... 38

3. IN THE BEGINNING: NEGRO HEALTH WEEK, 1915-1919...... 105

4. THE PRICE OF POPULARITY?: NATIONAL NEGRO HEALTH WEEK

AND THE EXPANDING ROLE OF THE MEDICAL ESTABLISHMENT,

1920-1930 ...... 204

5. THE LEADERSHIP OF THE PUBLIC HEALTH SERVICE: IT’S NOT

ABOUT CLEANING UP ANYMORE, 1931-1941 ...... 296

6. THE DEATH OF THE MOVEMENT: TIMELY OR UNTIMELY? 1942-

1950………………………………………………………………………...... 369

7. CONCLUSION ...... 436

BIBLIOGRAPHY ...... 447 x

LIST OF FIGURES

Page

FIGURE

1. 1927 NNHW BULLETIN COVER ...... 259

2. 1929 NNHW POSTER ...... 260

3. 1929 NNHW BULLETIN COVER ...... 260

4. PAGE 12 OF THE 1932 NNHW BULLETIN ...... 304

5. 1936 NNHW BULLETIN...... 350

6. 1941 NNHW BULLETIN COVER ...... 366

7. BACK COVER OF THE 1948 NNHW BULLETIN ...... 401

CHAPTER 1

INTRODUCTION

On July 7, 2008, the American Medical Association (AMA), the largest association of medical physicians and students in the United States, issued a press release apologizing for “its past history of racial inequality toward African-American physicians.”1 A panel of independent scholars prompted this apology when they found that from the AMA’s inception in 1847 until 1968, the Association supported “many state and local medical societies [that] openly discriminated against black physicians, barring them from membership and from professional support and advancement.”2 The discrimination that

African American physicians faced in gaining entrance into medical schools, getting credentials at hospitals, and acquiring acceptance in their field was deplorable. However, the AMA’s practices had repercussions outside of the medical profession. The panel concluded that the AMA’s “legacy of segregation, bias, and exclusion continues to adversely affect African American physicians and the patients they serve.”3

1 Associated Press, “Group Apologizes for Its Racial Bias,” New York Times, July 11, 2008, A15; “AMA apologizes for history of racial inequality and now works to include and promote minority physicians [press release].” www.ama-assn.org 7 July 2008,

2 Robert B. Baker, Harriet A. Washington, Ololade Olakanmi, Todd L. Savitt, Elizabeth A. Jacobs, Eddie Hoover, Matthew K. Wynia, “African American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide,” Journal of the American Medical Association 300(3) 2008: 306-314, 306.

3 Baker et al., “African American Physicians and Organized Medicine,” 306. 2

Indeed, racist AMA policies affected the entire African American community. From the nineteenth century through the early part of the twentieth century, the racism of white physicians led most to refuse to treat African American patients.

Without access to most white physicians, African Americans had few places to turn for health education and care, especially as medicine professionalized. Motivated by a combination of racism, professional superiority, and greed, physicians, most often white, led efforts to regulate and discredit alternative options for health care, such as midwives and folk healers.4 These lay health professionals were cheaper than doctors and lived in close proximity to those they served. This ease of access made them important to the poor of both races but particularly African Americans, the majority of whom lived in the rural

South as poor sharecroppers and domestic workers in the late nineteenth and early twentieth centuries.

Higher education expert Abraham Flexner’s 1910 report on medical education in the

United States illustrated the beliefs of many whites about black inferiority, white superiority, and the role of African Americans in health. Flexner asserted that “The medical care of the negro race will never be wholly left to negro physicians,” and that

“The practice of the negro doctor will be limited to his own race.”5 According to Flexner,

4 For regulating midwives, see for example Onnie Lee Logan as told to Katherine Clark, Motherwit: An Alabama Midwife’s Story (New York, NY: E.P. Dutton, 1989), x-xii; Margaret Charles Smith and Linda Janet Holmes, Listen to Me Good: The Life Story of an Alabama Midwife (Colubmus, OH: Ohio State University Press, 1996), 23, 65-102. For attacks on folk healers, see for example Paul Starr, The Social Transformation of American Medicine (New York, NY: Basic Books, 1982), 98-108; “It’s Health Week for the Negroes,” Morning Star, March 22, 1915, “THC, 1915,” 225, TA; “How to Keep Well,” Dr. Rich’d T. Hamilton, March 21-28, 1915, 887, “National Negro Health Week,” reel 713, BTW, TA; Dr. C. C. Middleton, “‘Better Babies,’ An Address Delivered by Dr. C. C. Middleton at Health Week Observance at urban League Headquarters,” Savannah Tribune, April 3, 1915, “THC, 1915,” 240-241, TA.

3 whites had to oversee black health education to ensure its proper employment. Even if blacks trained the way whites wanted them to, African American physicians would never be qualified to care for whites. Furthermore, Flexner asserted that black doctors needed to limit themselves to specific kinds of health work. A suitable medical education for an

African American focused on “hygiene rather than surgery,” making the black doctor essentially a sanitarian and very unlike his white medical professional colleagues.6

The medical establishment accepted Flexner’s conclusions about the inferiority of black health institutions.7 Both Flexner and the medical establishment overlooked the white racism rampant within the medical field. Flexner ignored the discrimination that had either denied blacks admittance to hospitals or segregated them in basements, leaving them under the most despicable conditions. He also omitted any discussion of the efforts white medical schools and hospitals made to get black corpses to use for studies, experiments, and dissections.8 The white supremacy that loomed over all these practices severely curtailed the ability of black health professionals to meet the needs of their community. Some African American leaders, such as W.E.B. Du Bois and members of the National Medical Association, challenged the medical establishment’s racism

5 Abraham Flexner, Medical Education in the United States and Canada, Bulletin no. 4 (New York, NY: Carnegie Foundation for the Advancement of Teaching, 1910), 180.

6 Flexner, Medical Education, 180.

7 The seven black medical schools in 1910: Howard University (Washington, D.C.); Flint Medical College (New Orleans); Leonard Medical School (Raleigh); Knoxville Medical College (Knoxville); Medical Department of the University of West Tennessee (Memphis); Meharry medical College (Nashville); National Medical College (Louisville). Of these, Flexner found only Howard and Meharry as worthy places for medical education. See Flexner, Medical Education, 180-181.

8 For more on the cadaver trade, see Daina Ramey Berry, The Price for Their Pound of Flesh: The Value of the Enslaved from Womb to Grave, in the Building of a Nation (Boston, MA: Beacon Press, 2017). 4 directly, attacking conclusions based on racist assumptions. Others, such as Robert

Moton and Booker T. Washington, looked for an alternative outlet to disseminate information on health care and education, National Negro Health Week.

This dissertation examines the rise and fall of the public health campaign that became

National Negro Health Week (NNHW), the only national public health campaign run by and for African Americans, which lasted from 1915-1950.9 While the Week went through many changes during its 35 years, at its most basic level, the Week’s goals were to: rally

African Americans around the importance of health; and to provide them with health education. The health information the Week stressed changed annually and ranged from hygiene and home cleaning tips, to characteristics of various diseases, to explanations about vaccinations and their importance. Sometimes the Week’s messaging could be part of a nationwide movement, such as the 1943 theme of “Health on the Home Front;

Victory on the War Front.” Other times the Week’s Committee chose one specific health practice to focus on, such as the 1929 theme “A Complete Health Examination for

Everybody.”

Each year, the Committee created materials, such as pamphlets, posters, and leaflets, to promote health education initiatives that the African American community would

9 Many historians place the beginning date of National Negro Health Week in 1915. This is what Booker T. Washington called it in his announcement, and what the program called itself in the following years. However, a more apt name for the campaign from 1915 through 1920 would be “Negro Health Week” (NHW) since the campaign did not have a national reach. Except for a few isolated observances (New York City, Chicago), the Week was primarily a Southern phenomenon until 1921 when the U.S. Public Health Service began participating and the week became “national.” That said, many of the elements of NHW are true of NNHW and so, while I use “NNHW” on the pages that follow to explain the overall program, what I write is true of NHW as well. Additionally, it is worth noting that the U.S. Public Health Service (PHS) took over running the Week in 1932 and the Surgeon General at the time, Hugh Cumming, was white. However, he put Dr. Roscoe C. Brown, an African American, in charge of the Week. Brown attended the 1921 Tuskegee Annual Conference and under President Franklin Roosevelt’s New Deal, Brown’s role as Director of the Office of Negro Health Work expanded. 5 focus on for a week during the end of March or beginning of April. A key feature of these materials was their minimal cost. Many of those who replied to calls to participate received them for free. Such prices removed many of the barriers to participation and encouraged those with limited financial means to organize a meeting or health talk. In addition, NNHW’s emphasis on tailoring health topics and discussions to local issues permitted those living in rural areas, approximately 90% of African Americans at the turn of the twentieth century, to organize grassroots NNHW celebrations.10

Although the overall goals of a particular year’s health campaign anchored NNHW, communities participated in a variety of different ways. Rural areas might dedicate only a day or two to the Week. Participants might hear a talk from a local physician, see a demonstration of proper outhouse construction, or join their neighbors in whitewashing their fences. In the cities, the Week relied more on established organizations to lead

NNHW. This arrangement could lead to impressive displays of shared health work. In

Cincinnati’s 1928 campaign, more than 30 social service groups supported the Week.

They combined their efforts to host meetings, organize speakers, and allocate funds for week-long clinics, sanitation removal, and painting activities.11 Other groups used

NNHW to promote their own health campaigns. The National Tuberculosis Association championed “A Complete Health Examination for Everybody,” in part as a way to reduce the impact of the disease. The American Red Cross utilized the war rhetoric of the 1940s

10 Karl E. Taeuber and Alma F. Taeuber, “The Negro Population in the United States,” in The American Negro Reference Book, ed. John P. Davis (Englewood Cliffs, NJ: Prentice-Hall, Inc., 1966): 96-160, 122; U.S Bureau of the Census, Statistical Abstract of the United States, 1910 (Washington, D.C.: U.S. Department of Commerce, 1910), 45.

11 William H. Ferris, “Where Black Meets White,” Philadelphia Tribune, 3 May 1928, 15. 6 to position the organization as the leader in first aid education. It even hired African

American nurses to teach classes on the topic throughout the country.12

Regardless of the groups involved or the health message, each NNHW broke down into component parts with a theme for each day. The first day of the campaign involved mobilizing and encouraging people to participate. Church services, with their built in attendance, were best, but school and community gatherings and picnics also provided the opportunity to get the NNHW message out. The NNHW Committee encouraged participants to spend several days focusing on the health of their homes, families, schools, and communities. The last day was for leaders to assess accomplishments and submit a report to the national NNHW headquarters.13

The reports revealed a massive campaign with millions participating by the 1940s. In

1941 for example, there were 13,635 lectures during NNHW across 6,837 communities in 36 states. Participants improved or constructed 8,214 outhouses and organized 2,600 clinics. Schools conducted 8,200 health pageants, plays, and competitions and 4,015 articles appeared nationwide on the Week’s observance. While the number of participants is hard to calculate, NNHW statistics put total attendance, when adding all participants at the various events together, at 4.2 million.14 By the late 1940s, attendance estimates more than doubled, to between 8.5 and 9.6 million.15

12 Pearl McIver, “Negro Nurses and the War Effort,” National Negro Health News (NNHN), 11(3) July-September, 1943: 5-6; “Red Cross Emphasizes Home Nursing,” Philadelphia Tribune, April 8, 1944, 8; “Week emphasizes Health of Home,” Chicago Defender, April 8, 1944, 18; “‘Healthy Family’ Theme of Negro Health Week,” Chicago Defender, April 7, 1945, 14; “Home Nursing Stressed by American red Cross Negro Health Week,” Philadelphia Tribune, March 31, 1945, 8; “The American Red Cross and Home Nursing,” NNHN, 13(1) January-March, 1945: 2-4.

13 NHW did not include a day for reporting.

Over the course of its existence, NNHW went through three major periods of development. The first involved its creation. Booker T. Washington promoted what became NNHW in 1915 on the heels of a number of African American efforts to improve their health. In 1906, W.E.B. Du Bois released The Health and Physique of the Negro

American. This book attacked racist tropes about black ill health and suggested the creation of “health leagues” throughout the black community.16 In 1908 Monroe Work became head of Tuskegee Institute’s Division of Records and Research. Among his many objectives, Work began to assess the financial impact of African American health.17 As interest in health grew, in 1912, Robert Moton started a health campaign in Virginia that became a statewide event by 1914 and attracted Washington’s attention.18

Work calculated that black ill health cost the nation as much as $300 million each year, a figure that ran counter to Washington’s emphasis on black economic self-

14 “Statistical Report: National Negro Health Week - 1941,” NNHN, 9(3) July-September, 1941: 2-3.

15 “National Negro Health Week Awards, Year 1947,” NNHN, 15(3) July-September, 1947: 1; “National Negro Health Week Awards, Year 1948,” NNHN, 16(3) July-September, 1948: 1; “National Negro Health Week Awards, Year 1949,” NNHN, 17(3) July-September, 1949: 1. I will discuss the accuracy of these figures in Chapter 6.

16 W. E. B. Du Bois, ed., The Health and Physique of the Negro American, Report of a Social Study made under the direction of Atlanta University, on May the 29th, 1906 (Atlanta, GA: The Atlanta University Press, 1906), 110.

17 Statement by Monroe Nathan Work to Lewis Al Jones, May 15, 1932, 2, folder 2, box 1, Monroe Nathan Work (MNW), TA. The school later changed the name of the department to the “Department of Records and Research.”

18 Sandra Crouse Quinn and Stephen B. Thomas, “The National Negro Health Week, 1915 to 1951: A Descriptive Account,” Minority Health Today 2(3) March/April 2001: 44-49, 44-45. This is a reprint from the Journal of Wellness Perspectives (now the American Journal of Health Studies 12(4) 1996: 172-179. See also Edward H. Beardsley, A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South (Knosville, TN: University of Tennessee Press, 1987), 102-103. 8 determination.19 Additionally, this research undermined Washington’s argument that whites should favor African American labor over immigrant alternatives.20 It also reinforced the narrative of racist white researchers who portrayed blacks as inherently unhealthy and even suggested that African Americans would soon become extinct.21 Thus motivated, Washington, Moton, and Work, all lacking the background in either public health or medicine that those launching health campaigns traditionally had, created just such a campaign.

Although Washington declared the public health campaign “National Negro Health

Week,” this was for publicity and fundraising purposes. For the most part observances occurred in cities and towns located in Virginia, Alabama, and elsewhere in the South, making a more accurate title for the campaign “Negro Health Week” (NHW).22 While

Washington died soon after his declaration, Robert Moton, Washington’s successor at

Tuskegee Institute, continued the campaign with the help of Monroe Work.

Support for the Week came from small donations and grants and through

Washington’s and Moton’s influence among African American organizations and

19 Monroe N. Work, ed., Negro Year Book and Annual Encyclopedia of the Negro, 1914- 1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 331.

20 Washington consistently argued that whites should hire African Americans instead of immigrants. See for example Booker T. Washington, Up From Slavery (Boston, MA: Doubleday, Page & Company, 1901), especially 82-93 on his Atlanta Exposition speech; Louis Harlan, Booker T. Washington: The Making of a Black Leader, 1856-1901 (New York, NY: Oxford University Press, 1972), especially 214-219.

21 See for example Frederick L. Hoffman, Race Traits and Tendencies of the American Negro (New York, NY: The Macmillan Company, 1896), 145-148.

22 Throughout this dissertation, “The South” includes the 11 former Confederate states, West Virginia, Delaware, Oklahoma, Kentucky, and Maryland. 9 newspapers. While physicians participated in local celebrations, Washington, Moton, and

Work ran the campaign without the oversight or input of any medical authorities.

In 1921, to fund, publicize, and expand the movement to the North and West, Moton asked the U.S. Public Health Service (PHS) to support the Week, ushering in the second period of development and turning NHW into a national campaign (NNHW). The participation and active interest of the PHS contrasted sharply with other groups educated whites led which often ignored African American health concerns.23 Medical organizations, such as the AMA, maintained policies of racial exclusion and African

Americans faced constant discrimination and segregation throughout this period in the

United States. Yet from 1921-1932, the PHS became ever more involved with the Week, in part as a way to promote the work of the newly reorganized Service.24 The PHS first published the Week’s pamphlets, then its posters and leaflets. At NNHW planning meetings, PHS representatives became more common and these meetings eventually moved from Tuskegee to Washington, D.C., making it easier for PHS officers to participate, but harder for Tuskegee’s leaders. PHS involvement gave physicians, medical professionals, and public health groups the opportunity to weigh in on NNHW health

23 Linda O. McMurry, Recorder of the Black Experience: A Biography of Monroe Nathan Work (Baton Rouge, LA: Louisiana State University Press, 1984), 116; David McBride, From TB to AIDS: Epidemics among Urban Blacks since 1900 (Albany, NY: State University of New York Press, 1991), 108; Edwin R. Embree and Julia Waxman, Investment in People: The Story of the Julius Rosenwald Fund (New York, NY: Harper & Brothers Publishers, 1949), 121.

24 Moton served as an advisor to both Presidents Woodrow Wilson and Warren Harding (in addition to later Presidents Calvin Coolidge and Herbert Hoover). It is not clear how much his relationship with these presidents affected the PHS’ decision to participate in NNHW. It is likely though that Moton’s status encouraged the PHS to more seriously consider his request than it otherwise might have. 10 messages. By 1927, the PHS cemented its influence when an African American dentist and PHS employee, Roscoe C. Brown, became Chairman of the Week.

PHS participation also allowed Moton to secure cheap production of NNHW materials and a network of health officers to publicize and support local NNHW participation. The number of NNHW celebrations increased substantially. In 1925, although estimates suggested a far higher figure, there were only 139 confirmed communities participating in NNHW. By 1931 the confirmed number was 1,325, with an estimated figure of almost double.25 What’s more, participation was now more evenly spread throughout the United States. The PHS’ publicity campaign for NNHW coincided with the Great Migration that saw African Americans move out of the South and across the country in search of greater economic opportunities, the migrants taking their interest in NNHW with them. By the end of the 1920s, one-fifth of all African Americans lived in

Northern and Western states and one-third in cities and towns.26 Although Alabama and

Georgia still maintained a large share of participating communities, NNHW celebrations began to spring up in Northern and Western states with small African American populations, such as Minnesota, Wisconsin, and Washington.27

25 “National Negro Health Week: 17th Annual Observance, Sunday, April 5, to Sunday, April 12, 1931,” U.S. Public Health Service (PHS), Washington, D.C., 1931, 14, folder 2, box 5, National Negro Health Week (NNHW), Tuskegee University Archives, Tuskegee, AL (TA); “Preliminary national Negro Health Week Announcement for the Eighteenth Annual Observance, Sunday, April 3, to Sunday, April 10, 1932,” PHS, Washington, D.C., N/D, 2-3, folder 2, box 6, NNHW, TA.

26 Edwin R. Embree, “Negro Illness and the Nation’s Health,” Crisis 36 (3) (March 1929): 84, 97; U.S Bureau of the Census, Statistical Abstract of the United States, 1935 (Washington, D.C.: U.S. Department of Commerce, 1935), 15.

27 “National Negro Health Week: 17th Annual Observance, Sunday, April 5, to Sunday, April 12, 1931,” PHS, Washington, D.C., 1931, 14, folder 2, box 5, NNHW, TA; “Preliminary 11

In 1932, complications from the Great Depression led to the PHS taking over

NNHW, the third period of development. Raising money to fund the Week had concerned the Week’s leaders from its inception and, even though the PHS printed the bulletin and posters, there were still significant costs associated with administration, revision, and publicity. The Great Depression forced institutions to rethink their philanthropic activities and where they spent their money. The Week’s traditional sources of financial support, such as the National Negro Insurance Association and the Julius

Rosenwald Fund, decided they could not or would not continue to fund the campaign.

Left with little recourse and having long had an interest in the government taking a more prominent role in African American welfare, Moton and the Week’s leaders urged the

PHS to take charge of the Week.

While it largely left the basic constructs and concepts of the Week untouched, the

PHS altered the NNHW Committee so that it consisted almost entirely of medical and public health professionals. The PHS wanted those on the Committee to have similar credentials to those in the Service, demonstrating to other medical professionals their expertise in running a health campaign. Additionally, these experts with professional degrees were more likely to see health issues in a similar way to those in the PHS, permitting the campaign to better coordinate with other PHS activities.

After the 1933 inauguration of President Franklin Roosevelt, the PHS’ financial support of the Week increased. While the cause of this increase in funding was more about the Democratic Party looking to attract more black voters and less about a new

national Negro Health Week Announcement for the Eighteenth Annual Observance, Sunday, April 3, to Sunday, April 10, 1932,” PHS, Washington, D.C., N/D, 2-3, folder 2, box 6, NNHW, TA. 12 interest in African American welfare, the funds led to an expansion of the Week.28

NNHW grew to have millions of participants each year. Yet black physicians fighting widespread practices of white supremacy throughout their careers grew increasingly concerned about a health campaign that encouraged the idea that black health problems were separate from those of whites. Their organized concern about the campaign culminated in its termination in 1951 as part of the effort to end the “negro medical ghetto” that separated the races.29

The creation, development, and demise of NNHW raise a number of historical questions. (1) Why did Booker T. Washington promote NHW? (2) How does NHW fit in with his philosophy about accommodation, industrial labor, and self-reliance? (3) How did African Americans outside of the medical profession understand and practice health?

(4) In what ways did those public health campaigns aimed at whites differ from those targeting blacks? (5) Since NNHW’s original leaders were not medical professionals, how did physicians, nurses and others in the medical establishment react to a health movement they did not lead? (6) How did complex medical ideas make their way to the lay public? (7) How and why did the Week change over time? (8) Finally how are issues of race and health connected and how do they relate to social control?

28 See for example: Sitkoff, A New Deal for Blacks; Weiss, Farewell to the Party of Lincoln; McElvaine, The Great Depression; Trotter, Jr., Black Milwaukee; Cohen, Making a New Deal; Greenberg, “Or Does It Explode?”; Sullivan, Days of Hope; Kryder, Divided Arsenal; Flamming, Bound for Freedom; Lauren Sklaroff, Black Culture and the New Deal: The Quest for Civil Rights in the Roosevelt Era (Chapel Hill, NC: The University of North Carolina Press, 2009). Prior to the 1930s, most African American voters supported the Rpublican Party, mostly out of loyalty to Abraham Lincoln and the Republicans of the 1860s who were responsible for emancipation.

29 Beardsley, A History of Neglect, 249-286; Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York, NY: Oxford University Press, 1995), 182-185; Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America 1890-1950 (Philadelphia, PA: University of Pennsylvania, 1995), 80. 13

The goal of this project is to show how lay African American health priorities differed from those of the medical establishment and the implications such differences created for the social control over, and empowerment of, African Americans. Booker T.

Washington promoted NHW as a way to implement his philosophy of black economic self-determination. That many African Americans in the South lived in poverty far away from medical facilities or professionals created a situation in which the average African

American missed work due to illness more often than a white worker. Better health was the obvious answer to improve this situation, but without access to medical professionals and the lack of resources available to most blacks, Washington’s health campaign differed from the health campaigns aimed at whites.

I argue that the Week’s emphasis on cleanliness, which focused on cheap strategies for cleaning, whitewashing, and basic hygiene, permitted African Americans of all classes to take action to improve their health without consulting a physician. While black people since slavery had taken care of their own health, the campaign formalized what had been personal actions into official public health practices. That is, the Week put “the science of protecting and improving the health of people and their communities” in the hands of the black lay public, rather than white medical professionals.30 The health practices that empowered blacks to combat disease on their own also encouraged

30 I am using the Center for Disease Control’s definition of public health. See “Public Health Connects Us All,” cdcfoundation.org < https://www.cdcfoundation.org/what-public-health> (12 May, 2020). This definition aligns with views held at the time, such as the chairman of the department of Public Health at Yale University Charles-Edward Amory Winslow who argued that public health involved preventing contagious diseases and prolonging life. See Charles-Edward Amory Winslow, The Evolution and Significance of the Modern Public Health Campaign (New Haven, CT: Yale University Press, 1923, reprint (South Burlington, VT: Yale University Press, 1984), 55-59. As this dissertation will show, the statement ending with this footnote was true for the beginning of NNHW as well, though it later changed. 14 communities to organize around other issues affecting their health, such as poor housing and city sanitation services.

The focus on the lay person as the primary tool to fight sickness, combined with the

Week’s grassroots nature and emphasis on community organization, which crossed racial lines, challenged the power of the white dominated medical establishment. The lack of professional medical leadership also made it different from most white public health campaigns. Black physicians in particular worried about the direction and impact of a health program non-medical professionals led. The Great Migration of African

Americans to the North during the late 1910s and into the 1920s exacerbated these worries as migrants brought interest in the Week out of the South.

However, when the U.S. Public Health Service began to participate, and especially after it took over the campaign in 1932, it repositioned the medical establishment as the ultimate arbiter of African American health. The Service changed the Week’s focus to promoting the importance of vaccinations and regular checkups. Part of this change was due to the widespread acceptance of hygiene practices. Another factor was the Great

Migration. As blacks moved into cities, they were not only in closer proximity to medical professionals, but they also faced vastly different health concerns than the rural southern population the campaign originally targeted. One other influence was the medical establishment’s interest in cornering the market on health care and ending the use of folk medicine and home remedies.31 By the 1930s the Week emphasized what medical professionals could do to improve black health, rather than what individual blacks could.

31 By “medical establishment” I mean the mostly white physicians, nurses, and members of public health groups who formed a consensus in the medical field about health. 15

In short, the PHS took a movement about lay health empowerment and turned it into a campaign to promote the mostly white medical establishment that continued to treat

African Americans and whites differently.

Historiography

Generally speaking, scholars have approached the topic of African American health and healthcare in two ways. The first focuses on medical institutions and often examines the discrimination blacks faced as medicine became professionalized in the late nineteenth and early twentieth centuries.32 This research examines black doctors and nurses in schools, hospitals, and medical associations. It demonstrates how white beliefs about people of color led to limited educational and treatment options for African

Americans. These limitations made it exceedingly difficult for African Americans to get proper medical care, leaving them with poor health outcomes that whites used to justify

Jim Crow practices and confirm their previously held racist beliefs. The principal actors in these narratives are black medical professionals and a few white philanthropists. This history focuses on elites and portrays the health conversation as top-down, with medical professionals in charge of the community’s health.

Exploring NNHW contributes to the body of work on African American health professionals since black doctors and nurses used the Week’s focus on black health problems as a way to emphasize the need for more black medical practitioners who could

32 See for example: Gamble, Making a Place for Ourselves; Darlene Clark Hine, Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890-1950 (Bloomington, IN: Indiana University Press, 1989); David McBride, Integrating the City of Medicine: Blacks in Philadelphia Health Care, 1910-1965 (Philadelphia, PA: Temple University Press, 1989); Harry F. Dowling, City Hospitals: The Undercare of the Underprivileged (Cambridge, MA: Harvard University Press, 1982). 16 then improve African American health outcomes. Here the Week also offers a different glimpse into the thoughts of African American physicians and nurses as they battled each other, along with Moton and Work, over the direction of the Week. These battles were largely independent of white philanthropy, introducing a relatively unexplored construct into this historiography while challenging the top-down portrayal of health conversations.

Studies of African American medical institutions have also revealed a common narrative: White medical professionals limited African American opportunities in the medical profession, and most nursing and medical schools excluded blacks. This situation forced African Americans to create these institutions on their own, a narrative the Week contributes to since Washington and Moton created NHW, in part, because there was no health campaign to aid African American health. Whites assailed black hospitals and medical schools and tried to oversee them either directly or indirectly. As noted at the beginning of this Introduction, they accused these schools of providing poor training to their graduates and creating an inferior class of medical professional. PHS takeover of

NNHW supports the overarching construct of whites overseeing African American health, though the reasons for PHS involvement in NNHW were significantly different.

Some African Americans also attacked black medical institutions. W.E.B. Du Bois and the NAACP argued that black hospitals, which became prevalent during the same time period as NNHW, encouraged the races to separate and contributed to segregation, a common criticism of NNHW. The white philanthropic organizations that supported these hospitals, such as the Julius Rosenwald Fund, came under attack as well for arranging special treatment and opportunities for black physicians. Critics considered these activities as paternalistic, and perceived the Rosenwald Fund’s efforts in particular, 17 which also included funding schools for African Americans, as contributing to segregation and racial inequality.33 Additionally, some felt that these acts perpetuated both a sense of black inferiority and white superiority as blacks seemingly could only receive equal medical training, or afford proper health care, through white philanthropy.34

Proponents of black hospitals argued that they provided an example of racial uplift by improving black health and demonstrating that blacks could take care of themselves.35

NNHW contributes to the debate over the utility of black only institutions, but from the new perspective of a public health campaign. Its supporters argued that the Week gave examples of blacks working to better themselves while detractors assailed the

“Negro” part of the Week as promoting segregation.

The second approach concerns the investigation of particular diseases.36 As with the previous method, this history tends to put medical professionals at the center of health

33 James D. Anderson, The Education of Blacks in the South, 1860-1935 (Chapel Hill, NC: The University of North Carolina Press, 1988), especially 156. Julius Roswenald also financed African American branches of the YMCA which were met with similar criticism, see Nina Mjakhij, “A Peculiar Alliance: Julius Roswenald, the YMCA, and African-Americans, 1910-1933,” American Jewish Archives 44.2 (fall/winter 1992): 584-605, 593.

34 Alfred Perkins, Edwin Rodgers Embree: The Julius Rosenwald Fund, Foundation, Philanthropy, and American Race Relations (Bloomington, IN: Indiana University Press, 2011), 149-152; Gamble, Making a Place for Ourselves, 182-186.

35 Vanessa Northington Gamble, “Roots of the Black Hospital Reform Movement,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, ed. Judith W. Leavitt and Ronald L. Numbers, 3rd ed. (Madison, WI: University of Wisconsin Press, 1997), 374-384.

36 See for example: McBride, From TB to AIDS; Samuel Kelton Roberts, Jr., Infectious Fear: Politics, Disease, and the Health Effects of Segregation (Chapel Hill, NC: University of North Carolina Press, 2009). Much of Keith Wailoo’s work utilizes this method as well, especially: Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill, NC: The University of North Carolina Press, 2001); Keith Wailoo and Stephen Pemberton, The Troubled Dream of Genetic Medicine: Ethnicity and Innovation in Tay-Sachs, Cystic Fibrosis, and Sickle Cell Disease (Baltimore, MD: The Johns Hopkins University Press, 2006); Keith Wailoo, How Cancer Crossed the Color Line (New York, NY: Oxford University Press, 2011). 18 decisions, with the African American patient demonstrating little agency. Using this method, historians have examined the ways in which medical practitioners engaged with, and treated, specific illnesses over time to illustrate how racial stereotypes affected perceptions of particular diseases and their potential treatments. These scholars, such as

Keith Wailoo and David Rosner, have argued that the concept of blacks as naturally diseased influenced African American relationships with health professionals, a narrative this dissertation supports. This idea led white physicians to ignore certain diseases and attribute them instead to the widely held perception that blacks had a fundamentally poor constitution. It is worth noting that many white ethnic groups who came to America received similar treatment. White native born physicians often ascribed diseases to their preconceived notions about unclean immigrants.37

In short, historians have concluded that health is socially constructed and tied to race.

As Keith Wailoo puts it “disease thought is inextricably bound to social thought and social relations.”38 The study of NNHW supports and furthers this work since the Week covered not only disease, but also specific social actions, such as hygiene and sanitation.

37 For African American examples see Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore, MD: The Johns Hopkins University Press, 1997), 200; Wailoo, Dying in the City of the Blues, 1-7; Wailoo, How Cancer Crossed the Color Line; David Rosner, “Introduction: ‘Hives of Sickness and Vice,’” in Hives of Sickness: Public Health and Epidemics in New York City, ed. David Rosner (New Brunswick, NJ: Rutgers University Press, 1995): 1-22, 9-16; Roberts, Jr., Infectious Fear, 1-6. For white ethnic examples, see Amy L. Fairchild, Science at the Borders: Immigrant Medical Inspection and the Shaping of the Modern Industrial Labor Force (Baltimore, MD: The Johns Hopkins University Press, 2003); Judith Walzer Leavitt, Typhoid Mary: Captive to the Public’s Health (Boston, MA: Beacon press, 1996); Suellen Hoy, Chasing Dirt: The American Pursuit of Cleanliness (New York, NY: Oxford University Press, 1995). Nayan Shah offers a similar discussion involving Asian Americans in Contagious Divides: Epidemics and Race in San Francisco’s Chinatown (Berkeley, CA: University of California Press, 2001).

38 Keith Wailoo, Drawing Blood, 200. See also Rosner, “Introduction,” 16. Suellen Hoy makes a similar point about cleanliness, particularly with regard to white immigrants. See Hoy, Chasing Dirt, 87. 19

A close examination of the Week reveals people strategically employing this concept of health to empower themselves, a level of nuance largely unexplored. Part of

Washington’s philosophy behind the Week involved African Americans publicly demonstrating their health to disprove racist beliefs about black ill health. He might have hoped that black use of white Victorian health ideals would also encourage whites to favor African American labor over immigrant alternatives and support his vision for black economic self-reliance.39

While scholars have explained how white and black medical professionals perceived health, those seeking to explore on how the African American population at large internalized health have largely concentrated their work on the role of women in local public health campaigns. These historians, such as Michele Mitchell, Tera Hunter, and

Susan Smith, have illuminated the important role women played in these campaigns.

NNHW provides another useful example of how their influence directed these programs to focus on hygiene and sanitation.40 Examining the NNHW campaign also illustrates the power and resources of individual black women as well as their organizations, such as the

National Association of Colored Women.

39 Washington consistently argued that whites should hire African Americans instead of immigrants. See for example Washington, Up From Slavery, especially 82-93 on his Atlanta Exposition speech; Harlan, Booker T. Washington: The Making of a Black Leader, especially 214- 219.

40 See for example: Tera W. Hunter, To ‘Joy My Freedom: Southern Black Women’s Lives and Labors After the Civil War (Cambridge, MA: Harvard University Press, 1997), 186-217; Michele Mitchell, Righteous Propagation: African Americans and the Politics of Racial Destiny After Reconstruction (Chapel Hill, NC: The University of North Carolina Press, 2004), 80-194; Smith, Sick and Tired of Being Sick and Tired, 20-32; Nancy Tomes, Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998), 186-231. 20

Given Washington’s early influence in the Week, this dissertation contributes to the historiography on the Wizard of Tuskegee as well. Washington believed that blacks should prove themselves worthy of first-class citizenship by focusing on industrial labor and self-reliance, working hard in their jobs to demonstrate their utility to whites.

Washington tried to involve white leaders and philanthropists in his work. He invited many to Tuskegee Institute so that they could see the benign nature of his methods for black self-help and improvement, and perhaps coax a donation from them.41 As the historian W. Fitzhugh Brundage has shown, early examinations of Washington portrayed his focus on industrial labor, economic self-reliance, and accommodation as making

African Americans dependent on white paternalism.42 However, the historians August

Meier and Louis Harlan, along with later scholars, have complicated this depiction. They argue that Washington picked his moments to challenge Jim Crow, citing, for example, money he secretly raised to challenge voter discrimination laws. They also argue that

Washington had to fund these efforts secretly because he lived in the South, where the slightest opposition to racial views carried grave risks. Such circumstances made his focus on accommodation and economic development reasonable.43

41 Washington, Up From Slavery; Louis Harlan, Booker T. Washington: Volume 2: The Wizard of Tuskegee, 1901-1915 (New York, NY: Oxford University Press, 1983).

42 W. Fitzhugh Brundage, “Reconsidering Booker T. Washington and Up From Slavery,” in Booker T. Washington and Black Progress: Up From Slavery 100 years later, ed. W. Fitzhugh Brundage (Gainesville, FL: University Press of Florida, 2003): 1-18, 3.

43 See for example Brundage, “Reconsidering Booker T. Washington and Up From Slavery,” 3-9; Robert J. Norrell, “Understanding the Wizard: Another Look at the Age of Booker T. Washington,” in Booker T. Washington and Black Progress: Up From Slavery 100 years later, ed. W. Fitzhugh Brundage (Gainesville, FL: University Press of Florida, 2003): 58-80; August Meier, Negro Thought in America, 1880-1915: Racial Ideologies in the Age of Booker T. Washington (Ann Arbor, MI: University of Michigan Press, 1964); Harlan, Booker T. Washington: Volume 2. 21

This dissertation supports the recent effort to cast Washington as a more active fighter against racial inequality. It argues that the act of promoting what became the NNHW campaign challenged the health status quo that white medical professionals had created regarding black health. Additionally, this dissertation builds upon the recent work of the historian Peter Coclanis’ discussion of Washington’s devotion to cleanliness. In particular, Coclanis asserts that Washington “believed that by changing their cleanliness behaviors, rural African Americans would not only improve their physical environment and enhance their physical health, but also gradually acquire, internalize, and routinize the virtues that would at once stabilize their social situations.”44 While Coclanis focused on Washington’s writing in Up From Slavery, the Week further supports Coclanis’ claim that Washington used the field of health as another iteration of Washington’s self- improvement philosophy.

The historiography on NNHW itself is relatively scant. Books on the U.S. Public

Health Service lack a detailed discussion of African American health policies and efforts.45 Scholars investigating the Julius Rosenwald Fund, which sponsored the Week between 1930 and 1932, have grappled with similar themes to those of NNHW, such as racial uplift and paternalism. However, most historians have concentrated on the Fund’s

44 Peter A. Coclanis, “What Made Booker Wash(ington)?: The Wizard of Tuskegee in Economic Context,” in Booker T. Washington and Black Progress: Up From Slavery 100 years later, ed. W. Fitzhugh Brundage (Gainesville, FL: University Press of Florida, 2003): 81-106, especially 92.

45 Fitzhugh Mullen, Plagues and Politics: The Story of the United States Public Health Service (New York, NY: Basic Books, 1989); Bess Furman, A Profile of the United States Public Health Service, 1798-1948 (Washington, D.C: U.S. Department of Health, Education and Welfare, 1974); George Rosen, A History of Public Health, Expanded ed. (Baltimore, MD: The Johns Hopkins University Press, 1993). Like Mullen and Rosen, Furman’s work did not mention National Negro Health Week, but on page 389 she did mention Roscoe Brown and his creation of a “Negro health service”, probably a reference to the “Office of Negro Health Work,” created in 1932 when the United States Public Health Service began running National Negro Health Week. 22 work in developing educational opportunities for African Americans in the South since this is where the Fund put most of its resources.46 Yet both the Fund, and especially the

PHS, put money and resources behind organizing and promoting the Week. Investigating

NNHW reimagines the priorities and roles of these groups in supporting African

American health.

Those discussing NNHW in greater detail have used a variety of methods and perspectives. Herbert Morais’ 1968 work, The History of the Negro in Medicine, charted the entire history of blacks in medicine. Morais portrays the Week as an important, but small element of the movement to improve African American health.47 Spending most of his time on its creation, Morais overlooks much of the following 35 years, due in part to

NNHW’s lack of medical professional leadership and then its leadership by the almost entirely white PHS. This dissertation argues that the Week played a vital role in helping

African Americans understand and improve their health and created opportunities for black physicians and nurses.

Sixteen years later, Linda McMurry’s Recorder of the Black Experience examined

Monroe Nathan Work, one of the principal developers of NNHW.48 Her work provides insight into the way NNHW evolved, portraying Work as the energy behind the Week.

46 Stephanie Deutsch, You Need a Schoolhouse: Booker T. Washington, Julius Rosenwald, and the Building of Schools for the Segregated South (Evanston, IL: Northwestern University Press, 2011); Mary S. Hoffschwelle, The Rosenwald Schools of the American South (Gainsville, FL: University Press of Florida, 2006); Peter M. Ascoli, Julius Rosenwald: The Man Who Built Sears, Roebuck and Advanced the Cause of Black Education in the American South (Bloomington, IN: Indian University Press, 2006); Perkins, Edwin Rodgers Embree.

47 Herbert Morais, The History of the Negro in Medicine (New York, NY: Publishers Company, 1967), especially 86-87 and 126-127.

48 McMurry, Recorder of the Black Experience. 23

According to McMurry, Work’s nagging persistence of Booker T. Washington got him to start the Week, and Work’s badgering of Moton convinced Washington’s successor to expand the campaign.49 However, because McMurry’s book is a biography of Work, her discussion of the campaign ends with the PHS takeover. Given her interests, she does not track changes in NNHW over time, such as how the campaign looked after the PHS takeover. Additionally, as biographies do, her book on the Week’s development puts

Work at the center, as opposed to the Week’s accomplishments. It may also have artificially highlighted Work’s contributions over that of others, since biographies focus on their protagonist of choice.

David McBride’s From TB to AIDS provides one of the first overviews, albeit brief, of the entire movement.50 His work concentrates on the transition of the Week from the

Tuskegee Institute’s control to that of the PHS, a topic that neither McMurry nor Morais discuss in depth. McBride argues that the PHS takeover provided, “A communication bridge for the federal public health movement into the black lay community at the local, personal, household level.”51 However, his focus on epidemics, leads him to quickly move on from this argument. This examination of NNHW sheds new light on McBride’s argument, connecting the grassroots elements with the mission and discussions at the national level. It also explains how other elements of PHS campaigns made their way into

49 McMurry, Recorder of the Black Experience, 112-115.

50 McBride, From TB to AIDS.

51 McBride, From TB to AIDS, 109. 24

NNHW materials, illustrating how PHS health policies and initiatives influenced

NNHW’s direction.52

Susan Smith’s 1995 work, Sick and Tired of Being Sick and Tired, still stands as the most in-depth discussion of the Week and Movement.53 In the two chapters Smith gives to the topic, her work sheds much light not only on how the Week operated, but also on the role that women played in publicizing, promoting, and organizing the campaign throughout the United States. As discussed earlier, she makes a well-honed and convincing argument about the leading role women took in health conversations and organization. Furthermore, Smith’s sources, which include material from the United

States Public Health Service and Tuskegee Institute Archives, along with personal interviews of several NNHW participants, make her work very persuasive. Nevertheless, her focus on gender leads her to spend most of her time examining NNHW work at the grassroots level.

This dissertation builds on Smith’s excellent gender analysis to incorporate national developments. Additionally, unlike Smith’s book, this dissertation consults African

American newspapers in a few major cities. Using this source material to chart year-by- year changes in policy in specific areas provides this dissertation with a way to see how the Week changed over time. Such change is more difficult to see in Smith’s work since her women often move in and out of leadership, forcing her to jump from location to

52 McBride, From TB to AIDS, 109-113.

53 Smith, Sick and Tired of Being Sick and Tired, 33-84. When the PHS got involved in the Week it began to refer to a year-round National Negro Health Movement which was to build on the efforts of the Week. The Movement became more established after 1932 and shared many of the policies, goals, and administrators of the Week. The emphasis on the Movement ebbed and flowed from 1932 to 1950 while the Week remained consistent. 25 location and year to year to find women working within NNHW. Lastly, using African

American newspapers makes it easier to compare the Week pre and post PHS takeover since the newspapers create a baseline for the Week’s observance.

Overall, the historiography on the subject of National Negro Health Week remains relatively sparse. This is surprising given the campaign’s longevity, its origins in Booker

T. Washington’s final years, and its operation by the U.S. Public Health Service for two decades and under three different U.S. Surgeons General.54 Beginning in 1932, the PHS dedicated an entire department, the Office of Negro Health Work, to this campaign to improve African American health.

Yet, ironically, at the same time as the U.S. Public Health Service decided to fund

National Negro Health Week, it also began the Tuskegee Syphilis Study. This Study, which lasted 40 years, examined the effects of syphilis on African Americans. The Study called for preventing treatment of its participants while, at the same time, National Negro

Health Week promoted treatment and awareness of syphilis and venereal diseases.55 That the PHS supported NNHW did not mean that it had overcome the rampant white racism of the early twentieth century. The PHS would never have withheld treatment from white patients as it did with African Americans enrolled in the Tuskegee Syphilis program. In this context, National Negro Health Week provided blacks with an opportunity to

54 U.S. Surgeons General during the National Negro Health campaigns: Hugh S. Cumming (1920-1936), Thomas Parran, Jr. (1936-1948), and Leonard A. Scheele (1948-1956).

55 For a brief overview of the Tuskegee Syphilis Study, see Alan Brandt, “Racism and Research: The Case of the Tuskegee Syphilis Study,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, ed. Judith W. Leavitt and Ronald L. Numbers, 3rd ed. (Madison, WI: University of Wisconsin Press, 1997), 392-404; for more depth, see James Jones, Bad Blood: The Tuskegee Syphilis Experiment (New York: Free Press, 1981). David McBride, From TB to AIDS, 106-113. 26 demonstrate that their health practices and concerns were the same as those of whites and the connections between the health of the two races.56

The historian Alondra Nelson has argued that the NNHW campaign was an early stage in the medical civil rights movement.57 NNHW helped organize African Americans around the topic of health, assess their health care options, and compare them to those of whites, raising awareness of inequalities in care and treatment. Indeed racial parity in health care was an early cause of the NAACP.58 Furthermore, since black health affected white health, NNHW encouraged interracial efforts to work towards solutions that would decrease differences in access to healthcare.59 Although NNHW rarely challenged racist practices, the NAACP recognized that issues of health closely connected with racial inequalities in income, housing, and government services throughout American society.

56 See for example “Thousands Attend First Public Health Conference,” Baltimore Afro- American, March 27, 1915, 1; “National Negro Health Week,” JNMA 14(1) 1922: 55-57, 56; “Getting Ready For Negro Health Week,” Louisville Courier Journal, April 4, 1925, “THC 1925,” 136-137, TA; “Negro Health Week Conference,” November 1, 1926, 4, folder 2, box 1, NNHW, TA; “Twenty Years After in Negro Health,” 2, March 15, 1934, Folder 6, Box 11, NNHW, TA; John P. Turner, “National Health Negro Wek – A Radio Broadcast,” NNHN, 12(3) 1944: 9-10 – originally in Journal of the National Medical Association (JNMA) 36(4) 1944: 118-119; “Self- Preservation,” The Atlanta Constitution, March 18, 1915, “THC, 1915,” 239, TA; W. Fitzhugh Brundage, “Reconsidering Booker T. Washington and Up From Slavery,” 9; Coclanis, “What Made Booker Wash(ington)?,” 92; Roberts, Jr., Infectious Fear, 214. The National Negro Health News also ran many articles promoting the similarities in health concerns between the two races, see for example: “Infantile Paralysis No Respecter of Race, Medical Expert Says,” NNHN 12(1) 1944: 2; “Is the Negro More Susceptible to Syphilis Than the White Man?” NNHN 12(1) 1944: 5.

57 For more on the idea of the relationship between Civil Rights and NNHW, see Alondra Nelson, Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (Minneapolis, MN: University of Minnesota Press, 2011), especially 23-48.

58 Karen Kruse Thomas, “The Hill-Burton Act and Civil Rights: Expanding Hospital Care for Black Southerners, 1939-1960,” Journal of Southern History 72(4) November 2006: 832-870, 837-840.

59 Over the years, the NNHW program partnered with a number of organizations led by whites, such as the American Public Health Association, the American Social Hygien Association, the American Red Cross, the Children’s Bureau, and the PHS. See also Roberts, Jr., Infectious Fear, 214; Thomas, “The Hill-Burton Act and Civil Rights,” 832-870; Dennis A. Bethea, “Why a Health Week?” Baltimore Afro-American, April 10, 1948, M13. 27

Thus, as the NAACP, NMA, and other groups began to demand equal access to public health services, these issues became linked with the larger issue of civil rights and citizenship.

Methodology

One of the reasons NNHW has received little attention has to do with the limited source material available. As Susan Smith explains, “After years of exhaustive searching, with assistance from Aloha South of the National Archives and Peter Hirtle of the

National Library of Medicine, I was never able to locate the records of the Office of

Negro Health Work at the Public Health Service or the personal papers of Dr. Roscoe C.

Brown [head of the Office of Negro Health Work]. All indications suggest that they are no longer available.”60 This situation makes the last 18 years of the Week difficult to examine and leaves the Week’s journal, the National Negro Health News, as the main source of NNHW leadership thinking. However, working with Tab Lewis of the Textual

Reference Archives II Branch of the National Archives and Records Administration, we found a new collection of annual posters and pamphlets for the Week that few historians have examined. A close reading of these materials allows for better insight into the mindset of NNHW leaders than historians have heretofore achieved and permits for a better comparison of the Week before and after the PHS takeover.

Additionally, the Tuskegee University archives contain a large collection of National

Negro Health Week materials, including letters, notes, and reports sent to the national

NNHW Committee. These materials, written by and for people of all different economic

60 Smith, Sick and Tired of Being Sick and Tired, note 4, 59, 191. 28 classes, provide a useful vantage point to investigate the Week. In addition to these materials, the University contains a collection of newspaper clippings of articles on

NNHW. The vast majority of these stories come from southern newspapers that focused on African American readers, such as the Savannah Tribune and Houston Informer.

My study supplements the material in the archives with extensive use of black newspapers, specifically the Chicago Defender, the Philadelphia Tribune, and the

Baltimore Afro-American. These papers are useful because, first, they all span the time period discussed and contain many articles on the Week. Their interest was in part due to the racial uplift the campaign promised, a goal that many black newspapers promoted to their readers. Second, they continually reported on the Week’s events in their respective cities and surrounding areas, making them useful for understanding the strength and manifestations of the campaign throughout the country.61 Third, their diverse locations offer a variety of perspectives on the Week and its effects, allowing for comparisons between locales. Thus, this dissertation intersperses a national vision and strategy with how locals carried out these agenda.

Chapter Summaries

61 Booker T. Washington had significant influence at many of these papers, such as the New York Age, The Indianpolis Freeman, and the Chicago Leader. In particular he had a close relationship with T. Thomas Fortune, the editor and co-owner of the Age and counted the many editors of The Freeman as supporters as well. Both these papers at times ran articles that Washington either asked or paid them to run. Washington later purchased the New York Age, subsidized the Leader, and worked to get his supporters installed at black newspapers throughout the North. For more on this see Emma L. Thornbrough, “More Light on Booker T. Washington and the New York Age,” The Journal of Negro History 43(1) (January 1958): 34-49; August Meier, “Booker T. Washington and the Negro Press: With Special Reference to the Colored American Magazine,” The Journal of Negro History 38(1) (January 1953): 67-90; Harlan, Booker T. Washington: Volume 2, 96-106. 29

This dissertation takes a chronological approach to examining the Week. Chapter 2 analyzes the reasons why a public health campaign interested African American leaders.

Working as domestic servants and sharecroppers, African Americans made little money and often had no choice but to stay in dirty, crowded, and unhealthy conditions. These circumstances left blacks with a much lower life expectancy and much higher rates of death for almost all diseases compared to whites. Problematically, African Americans had few places to turn for their health needs. Most lived in the rural South, far from the few available black doctors or white medical professionals willing to treat them.62 The high cost of medical professionals and past experiences of poor treatment made African

Americans reluctant to seek health professionals and the professionalization of medicine made using folk remedies increasingly taboo. The combination of geography and racism made it difficult for blacks to improve their health, or even learn what proper health entailed. Therefore, some outside of the medical profession took health concerns into their own hands, leading health education initiatives in their communities. They publicized cheap and easy to understand ways of maintaining health outside of the doctor’s office. They made health a focus of community organization and found whites willing to work with them. These small local movements attracted the attention of Booker

T. Washington and laid the groundwork for what became National Negro Health Week.63

62 U.S Bureau of the Census, Statistical Abstract of the United States, 1926 (Washington, D.C.: U.S. Department of Commerce, 1927), 13; Reynolds Farley, Growth of the Black Population: A Study in Demographic Trends (Chicago, IL: Markham Publishing Co., 1970), 41; W. Michael Byrd and Linda A. Clayton, An American Health Dilemma: A Medical History of African Americans and the Problem of Race, vol. 2 (New York: Routledge, 2002), 398; Julian H. Lewis, “Number and Geographic Location of Negro Physicians in the United States,” Journal of the American Medical Association 104(14) April 11, 1935: 1272-1273.

Chapter 3 argues that given the many barriers that prevented African Americans from accessing professionalized medicine, Booker T. Washington, Robert Moton, and Monroe

Work concentrated on cheap strategies that blacks could use at home. They created clear guidelines in the 1915 Negro Health Week campaign about whitewashing, sanitation, and basic hygiene to improve health outcomes. In short, the Week allowed everyday black people to begin to understand the basics of disease transmission and take matters of health into their own hands in formalized ways. While some white public health campaigns also advocated these practices, most had medical professionals in leadership positions and used doctors to advance their health education. This chapter argues that the small number of black medical professionals forced the Week’s leaders to turn to people outside of the medical community to support NHW’s work. While the decision worried some in the black medical community, the campaign used clear, non-medical language to support black health. Additionally, Washington believed the use of Victorian practices would demonstrate black respectability and encourage interracial cooperation. Given

Washington’s accomodationist philosophy, NHW did not attempt to challenge the racist practices that kept African Americans from accessing, and becoming, medical professionals. Instead, this chapter argues that NHW often relied on capitalist arguments about how black health would benefit whites to entice whites to support black health.

Prior to 1921, the Week was mostly a Southern phenomenon. The vast majority of blacks lived in the South where the organizations cooperating with NHW had strong

63 Quinn and Thomas, “The National Negro Health Week, 1915 to 1951,” Minority Health Today, 44-45. The authors refer to a number of events, including Monroe Work’s creation of a Men’s Sunday Club, Du Bois and the Atlanta Conferece in 1906, and Robert Moton’s work with the Negro Organizaiton Society of Virginia. 31 support. Chapter 4 argues that two factors combined to make NHW into a national campaign. One was the participation of the U.S. Public Health Service. The PHS agreed to support the campaign due to a combination of Robert Moton’s political clout as heir to

Washington and an advisor to President Woodrow Wilson and the advocacy of African

American dentist and PHS employee Roscoe C. Brown. With the PHS as a partner, NHW became NNHW. The PHS provided more press coverage, health department support, and opportunities for interracial work across the country. Its endorsement of NNHW convinced many white-led health groups to participate. The Great Migration also factored into this expansion as African Americans moved north and brought interest in the campaign with them. As the campaign developed, this chapter argues that women were particularly important figures in local NNHWs. Black doctors too increased their support.

However, they thought their medical education gave them the right to control black health education policy. As hygiene practices became more accepted, NNHW began to decrease its emphasis on healthy actions individuals could take. In its place were calls for regular visits to physicians and the need for vaccinations to ensure “proper” health. While subtle at first, these suggestions, impractical for most blacks, gained traction as medical professionals entered NNHW leadership and medical practice continued to professionalize. By the end of 1930, the campaign’s focus on cleanliness and health practices remained, but there was a growing insistence that they were not enough.

When the effects of the Great Depression threatened to terminate the campaign, the

PHS took it over. Chapter 5 analyzes the impact of this PHS decision between 1931 and

1941. Some African Americans saw the takeover as recognition that the U.S. government 32 was at last taking the plight of African American health seriously.64 However, this chapter puts the takeover in the context of President Franklin Roosevelt’s New Deal policies. Government support of NNHW aimed to illustrate Roosevelt’s interest in black welfare and secure the black vote even as New Deal policies restricted African American access to economic relief during the Great Depression. Brown, now the Week’s chief organizer, launched a quarterly periodical, the National Negro Health News to streamline participation, conduct annual assessments of health work, and increase publicity. By

1941, NNHW attracted millions of participants across religious groups and geography, from urban and rural areas, north and south. At the same time, NNHW continued promoting the medical establishment. The number of NNHW talks medical professionals gave increased and the Week’s materials advocated regular checkups and seeing a physician when ill. Medical professional influence in NNHW leadership was only partly responsible for these changes. Another factor was the continued black migration out of the rural South to more populated areas where blacks faced different health concerns and had greater access to doctors. By the eve of World War II, the Week’s massive expansion and popularity aligned with an overt emphasis on supporting the medical establishment and limited the role of lay health education that had been a foundation of the Week.

During the war, the PHS emphasized the concept of health patriotism. NNHW dutifully took up this call to promote health as the way to get the best out of both workers and soldiers to win the war. However, chapter 6, which spans the period from 1942-1950, argues that health patriotism carried with it the implication of health equality, that all healthy people could make an equal contribution to the war effort. After the war, the

64 Jesse O. Thomas, “N/T” Atlanta Constitution, March 12, 1934, “THC, 1934,” 663, TA. 33 economic gains blacks made combined with the broad black participation in the war to increase the drive for civil rights. The NAACP used the war as a springboard to successfully attack segregation in this decade and the next as they and other groups began to demand integration. As African American support for black hospitals and clinics declined, this chapter argues that NNHW came under increasing attack as it implied blacks and whites faced different health concerns. The efforts of the leaders of these organizations, such as Walter White of the NAACP and Dr. W. Montague Cobb of both the NMA and NAACP, bore fruit as nursing associations integrated and black doctors gained acceptance into various medical associations. Although NNHW’s data painted the picture of a vibrant movement with mass appeal, a thorough examination of the statistics reveals evidence of overestimates that belied a Week faltering in popularity as demands for ending segregation in health increased. As the decade wore on, the campaign received louder criticism until the Federal Security Agency terminated the program after 1950.

Conclusion

The study of NNHW illustrates how medical ideas become accessible to subjugated classes and the importance of health perceptions in shaping ideas about race. In the early

1900s, the white perception of African Americans as inherently unhealthy permeated

American society and affected black-white relations. White physicians’ racist beliefs made them reluctant to treat black patients or license black doctors and many thought that black health practices could only change through the use of force. Consequently, many

African Americans, especially the poor, came to mistrust health officials. Combined with both enforced and self-selected segregation, blacks suffered greater rates of death and 34 disease than others.65 The Week provided Booker T. Washington with another front on which he could promote black racial uplift in a benign way that would not upset his white philanthropic supporters. Washington connected healthier blacks with improved white health and an increase in both black and white income. By focusing his health movement on hygiene and sanitation, he hoped to give African Americans easy ways to improve their health that all could implement. Since most of the South’s rural black population distrusted doctors and was unable to access medical professionals due to cost and location, non-medical professionals became the leaders of this health movement. Health improvement aligned with Washington’s philosophy of black economic self- determination in that healthier African Americans would miss less work and thus earn more money. Increased black health would also undermine arguments for segregation and other racially discriminatory practices.

African American health improved, but NNHW was not the primary cause. Decreases in African American rates of most diseases along with the overall death rate coincided with the massive expansion and improvement in their access to housing, sanitation, income, and access to municipal services. While NNHW encouraged communities to assess local health concerns, the Week mainly focused on what African Americans could do on their own to improve their health. Sweeping, dusting, and painting had their role in staving off illness and demonstrating black respectability, and perhaps changing some white attitudes about black health. However, the campaign did not challenge the racism

65 Jim Downs, Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction (New York, NY: Oxford University Press, 2012), 69; Hunter, To ‘Joy My Freedom, 205; Michael Willrich, Pox: An American History (New York, NY: The Penguin Press, 2011), 5-7, 47-212. 35 that often left African Americans facing the unhealthiest conditions. While the campaign called for more black physicians and nurses, it did not attack the discriminatory practices that served to limit the numbers of these health professionals.

Overall, the Week was successful in getting African Americans interested in their own health and providing basic health education to improve health when no alternatives were available. Over time it became the program with the broadest reach into the African

American community to disseminate health ideas at a time when many blacks did not trust, and did nto have access to, physicians. By participating, blacks also challenged some of the racist reasons whites gave for the second-class status of African Americans in society, such as that blacks were inherently ill and uncivilized.

Yet the Week’s longevity was due to a combination of political calculation and its accomodationist bent in not attacking the status quo that kept many blacks from accessing medical services. The Week provided a palatable way for white leaders to show they supported black interests without having to acknowledge that many of the policies whites implemented contributed to black ill health. While local NNHW leaders used the campaign to publicize inequalities in municipal services and expand these services to

African Americans, they did not challenge white institutions. NNHW asked for just a little of what whites had in terms of sanitation, health, and municipal services, not equality. As hygiene practices became widely accepted and black income rose, NNHW’s efforts at empowerment and racial uplift decreased. Instead, with medical professionals installed in NNHW leadership, the campaign turned to championing the use of the medical establishment as more blacks came to live near physicians and, after World War

II, could afford their services. Although the Week created opportunities for interracial 36 work, real systemic change did not begin (and still has a long way to go) until the

NAACP, NMA and other groups began to rally African Americans around the institutional racism in medicine and elsewhere. Once they did, NNHW became part of the medical segregation these groups fought against.

In addition to discussing a largely overlooked story, this dissertation touches on many topics that have shaped modern healthcare. It examines issues of racial health disparities that still exist today, and which the Coronavirus has brought into stark relief. Many people of color work “essential jobs” while suffering from higher rates of underlying health conditions, less access to care, and poor housing due to systemic racism, making them more susceptible to COVID-19.66 This dissertation also investigates the struggles of

African American professionals in a society with systematic racism, black mistrust of medical professionals, and the lack of racial diversity among the medical establishment.

While this dissertation discusses many of these topics only briefly, they are the background that shapes the story and explains why this part of history is still relevant in today’s world.67

In the context of the racism and health inequalities that people of color still face, the recent efforts to overturn the Affordable Care Act, which would increase the number of

66 Eugene Scott, “4 Reasons Coronavirus is Hitting Black Communities so Hard,” washingtonpost.com 10 April 2020 (24 June 2020). Examples of “essential jobs” include city bus driver and food service workers.

67 Some of the ideas here come from David Lazris, “Survival and Progress: The National Medical Association and Black Medical Professionalism, 1865-1929,” Bachelor of Arts Thesis, Brown University, Providence, RI, 2017, 14. 37 uninsured Americans to almost 60 million by 2026, take on a greater importance.68 The impact of a repeal would largely fall on people of color, those still struggling for equal access to the medical establishment today. If, as argued here, people connect thoughts about disease to social relations in society, then how will society treat those without the regular care of the medical establishment? While such policies might save the government money in the short term, the study of NNHW illustrates the connection between race and health and the need for more consideration of the ramifications such health policies have on race relations.

68 Madison Park, “Here’s how many would be uninsured in each health care scenario,” cnn.com 18 July 2017, (26 July, 2018); Dan Mangan, “Obamacare pushes nation’s health uninsured rate to record low 8.6%,” cnbc.com 7 September 2016, < http://www.cnbc.com/2016/09/07/obamacare-pushes-nations-health-uninsured-rate-to-record- low.html> (7 November, 2016); The Commonwealth Fund, March, 2015, 2; National Center for Health Statistics, Summary Health Statistics Tables for the U.S. Population: National Health Interview Survey, 2016 (Washington, D.C.: Government Printing Office, 2016), 1. In 2020 the number of uninsured Americans would increase immediately by 23 million. See Sheryl Gay Stolber, “Trump Administration Asks Supreme Court to Strike Down Affordable Care Act,” nytimes.com 26 June 2020, (26 June 2020); Meagan Flynn and Tim Elfrink, “Trump administration asks Supreme Court to strike down Obamacare,” washingtonpost.com 26 June 2020, (26 June 2020. 38

CHAPTER 2

WHAT DOESN’T KILL YOU DOESN’T NECESSARILY MAKE YOU STRONGER:

THE STATE OF, AND PERCEPTIONS ABOUT, AFRICAN AMERICAN HEALTH,

1890-1914

“Properly Diagnosed”

Stranger – Doctor, I ache all over. Doctor – Malaria, probably. Stranger – And my head is all stuffed up and I have a tearing cough. Doctor – A little cold along with it, I see. Take – Stranger – And I just feel as if this world was a fraud and I’d like to throw that old moon at the sun and stuff all the stars down somebody’s throat. Doctor – You’ve got the grip.

-Chicago Defender, August 5, 1911, p. 8.

Posted in the “Scraps of Humor” section of Chicago’s leading black newspaper, the

Chicago Defender, this joke carried a double-meaning for African Americans in the early

1900s. The grip, often spelled “grippe,” was a reference to influenza, a common disease of the time. The joke was that doctors often assigned influenza as a catch-all. However, there is a darker element to this comic exchange. The Stranger is upset with the state of the world and wants to lash out, feelings that would have resonated with African

Americans who faced racism throughout the nineteenth and early twentieth centuries. Yet the Doctor, a person charged with curing problems, reacts to the Stranger in two distinct ways. First, the Doctor does not examine the Stranger, merely reacting to each stated malady and offering a potential solution. As this chapter demonstrates, blacks would have found this hands-off approach to African American health familiar. The medical 39 establishment either overlooked black health problems or perceived them as endemic to the race, meaning that nothing could be done. In this context, the second meaning of the joke becomes apparent. As the Stranger complains about how terrible the world is, the

Doctor’s statement “You’ve got the grip,” which uses the traditional spelling of “grip,” explains that the Stranger understands the situation properly. Many structures and practices restricted African Americans, who often felt frustration that they could not change their plight. And most doctors of the time, the majority of whom were white, had little interest in changing the situation.

The Mid to Late 1800s

Prior to the Civil War, African Americans found themselves on the fringes of

American society. Their skin color made them social outcasts, as did their enslavement in the South. The few free blacks in the North faced overt restrictions on the types of jobs and housing available, leaving them little opportunity to improve their status. While

Northern blacks had to fend for themselves when ill, those in the South found some support from their white masters seeking to protect their economic investments.

However, the lack of medical infrastructure and the vast distance between plantations made treatment difficult. Although white masters asked local physicians for help, many permitted, and even encouraged, slaves to use African healing practices.1 Thus, on the

1 Jim Downs, Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction (New York, NY: Oxford University Press, 2012), 69; Sharla M. Fett, Working Cures: Healing, Health, and Power on Southern Slave Plantations (Chapel Hill, NC: The University of North Carolina Press, 2002), 49-83; Rana A. Hogarth, Medicalizing Blackness: Making Racial Difference in the Atlantic World, 1780-1840 (Chapel Hill, NC: The University of North Carolina Press, 2017), 160-167. Some historians have noted the role of healing in slave 40 plantation, informal folk medicine took place alongside the scientific as whites accepted a

“by any means” approach to protecting their slave assets. Northern blacks also turned to home remedies and traditional methods as most found that doctors either refused to see them or were too expensive. Although a greater proportion of whites had the opportunity to see a physician, many still used alternative health professionals during this period as well.2 There was not yet a true medical establishment and the line between folk and orthodox medicine was not particularly clear.

How to maintain one’s health and what it meant to be “healthy” were not only ambiguous, but also varied based on region, class, gender, and belief system.3

Additionally, the lack of an organized medical establishment permitted health definitions to come from a wide range of people. In 1850, there were only 52 medical schools in the country. These institutions could not agree on a standard curriculum, requirements for graduation, or even definitions of disease and proper treatment procedures, creating unevenly trained “professionals.”4 Consequently, the few who graduated from medical

religion, see for example Bettye Collier-Thomas, Jesus, Jobs, and Justice: African American Women and Religion (New York, NY: Knopf, 2010), 72.

2 For some examples, see Guenter B. Risse, Ronald L. Numbers and Judith Walzer Leavitt, eds. Medicine Without Doctors: Home Health Care in American History (New York, NY: Neale Watson Academic Publications, Inc., 1977).

3 See for example: Stephen Nissenbaum, Sex, Diet, and Debility in Jacksonian America: Sylvester Graham and Health Reform (Westport, CT: Greenwood Press, 1980); Collier-Thomas, Jesus, Jobs, and Justice; E. Anthony Rotundo, “Body and Soul: Changing Ideas of American Middle-Class Manhood, 1770-1920,”Journal of Social History, 16 (Summer 1983), 23-38; Steven Reiss, City Games: The Evolution of American Urban Society and the Rise of Sports (Champaign, IL: University of Illinois Press, 1991).

4 Paul Starr, The Social Transformation of American Medicine (New York, NY: Basic Books, 1982), 112; Barbara G. Rosenkrantz, “Cart Before the Horse: Theory, Practice and Professional Image in American Public Health, 1870-1920,” Journal of the History of Medicine and Allied Sciences 29 (January 1974), 55. Steven M. Stowe argues that a physician’s experience, rather than education, was the determining factor in how a doctor practiced, see 41 school competed for patients in a crowded field of plantation owners, merchants, folk medicine, female heads of households, and even religious leaders.5 All these people had standing because, as the historian David Rosner explains, “Much of public health practice as well as medical therapeutics rested on the belief that disease was a reflection of individuals’ special social, personal, hereditary, and economic circumstances.”6 Given that so many different concerns might affect a person’s health, a wide variety of people could realistically provide a way to aid the ill.

After emancipation and the end of the Civil War, the medical profession, like university education, began to move towards standardization.7 Institutions started to agree on methods of training and states began to set guidelines for what constituted a

“physician.” In this atmosphere, doctors needed to not only agree on a wide variety of health matters, but also to convince the public that physicians had the best answers to medical problems. Thus, doctors as a group had to demonstrate their expertise to the public on a regular basis. This situation led Northern doctors to defer to Southern white physicians on African American health. Northerners assumed that two centuries of

Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century (Chapel Hill, NC: The University of North Carolina Press, 2004).

5 For more on the variety of health practitioners prior to the late 1800s, see Risse, Numbers and Leavitt, eds. Medicine Without Doctors.

6 David Rosner, “Introduction: ‘Hives of Sickness and Vice,’” in Hives of Sickness: Public Health and Epidemics in New York City, ed. David Rosner (New Brunswick, NJ: Rutgers University Press, 1995), 9.

7 For more on the standardization of university education, see Laurence Veysey, The Emergence of the American University, 1865-1915 (Chicago, IL: University of Chicago Press, 1970). Starr, The Social Transformation of American Medicine; W. Michael Byrd and Linda Clayton, An American Health Dilemma: The Medical History of African Americans and the Problem of Race: Beginnings to 1900, vol. 1 (New York, NY: Routledge, 2000), 375. 42 slavery had granted Southerners insight into the ways to handle black health.8 Indeed,

Southern medical schools and doctors in need of cadavers, patients on which to practice diagnoses, and other “clinical material” often used slaves and even free African

Americans.9 This Northern reliance on Southern expertise, combined with Southern interest in maintaining white dominance of the social order and preconceived notions about the limits of black intelligence and inherited criminal traits, helped to begin to cement the idea in whites that African Americans had pervasive ill health.10

The poor economic circumstances that blacks faced after the Civil War reinforced such opinions. The laws of the Jim Crow South combined with less formal hiring restrictions in the North to confine the grand majority of African Americans to the lowest paid jobs and the worst accommodations. Physicians used the squalor and generally poor conditions that blacks lived in to confirm that African Americans did not value their

8 David McBride, From TB to AIDS: Epidemics among Urban Blacks since 1900 (Albany, NY: State University of New York Press, 1991), 18; Downs, Sick from Freedom, 1-70; Margaret Humphreys, Intensely Human: The Health of the Black Soldier in the American Civil War (Baltimore, MD: The Johns Hopkins University Press, 2008), 67-68.

9 Harriet A. Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York, NY: Doubleday, 2006), 103- 142; Fett, Working Cures, 151-153; Hogarth, Medicalizing Blackness, 163-180. For medical experimentation and African American women, see Deirdre Cooper Owens, Medical Bondage: Race, Gender, and the Origins of American Gynecology (Athens, GA: University of Georgia Press, 2017). For more on the cadaver trade, see Daina Ramey Berry, The Price for Their Pound of Flesh: The Value of the Enslaved from Womb to Grave, in the Building of a Nation (Boston, MA: Beacon Press, 2017).

10 James Jones, Bad Blood: The Tuskegee Syphilis Experiment (New York, NY: Free Press, 1981), 17; John S. Haller, Jr., Outcasts from Evolution: Scientific Attitudes of Racial Inferiority, 1859-1900 (Chicago, IL: University of Illinois Press, 1971), especially 40-69; Byrd and Clayton, An American Health Dilemma, vol. 1, 61. For more on the connection whites made between blackness and criminality, see Khalil Gibran Muhammad, The Condemnation of Blackness: Race, Crime, and the Making of Modern Urban America (Cambridge, MA: Harvard University Press, 2010). Christopher D. Willoughby provides an excellent overview of the development of medical thought on race, see “ ‘His Native, Hot Country’: Racial Science and Environment in Antebellum American Medical Thought,” Journal of the History of Medicine and Allied Sciences 72, no. 3 (July 2017): 328-351. 43 environment and that they were unable to figure out how to live healthy lives. The low pay blacks received had a compounding effect in that few could afford a “qualified” physician. Even those who had the money had trouble locating a doctor who would see a black patient. Thus, like poor whites, many African Americans turned to the methods used prior to emancipation to treat their diseases. They relied on folk remedies and traditional medicine plied by mothers, sisters, and daughters; their medical isolation contributing directly to their social isolation.11 However, by the late nineteenth century, the use of non-medical personnel for treating diseases began to carry a stigma. African

Americans were in a no-win situation. Most could not afford, or did not have access to, the medical establishment’s healing methods and, for those who did, the establishment deemed them less of a priority to treat than whites. Yet if blacks sought help outside of the professional health worker, the medical establishment used this decision as confirmation of the backwardness of the race and its “physical and mental inferiority” to whites.12

Such conclusions, often used to support arguments for white superiority to legitimize white behavior towards other races, led some experts to go so far as to predict black extinction. According to Charles Darwin, “at some future period…the civilized races of man will almost certainly exterminate and replace the savage races throughout the

11 Patricia J. Fanning, Influenza and Inequality: One Town’s Tragic Response to the Great Epidemic of 1918 (Amherst, MA: University of Massachusetts Press, 2010), 8; Byrd and Clayton, An American Health Dilemma, vol. 1, 408; Downs, Sick from Freedom, 14-40. For more on poor whites and health care in the late 1880s, see Charles E. Rosenberg, “What It Was Like to Be Sick in 1884,” American Heritage (Oct./Nov. 1984): 23-31.

12 Jones, Bad Blood, 17. By “medical establishment” I mean the mostly white physicians, nurses, and members of public health groups who formed a consensus in the medical field about health. 44 world.”13 For Darwin, survival of the fittest meant the death of the unfit.14 Others perceived the African American propensity for sickness as confirmation that blacks were not part of the same evolutionary process as Caucasians.15 Those supporting this conception tended to seize on emancipation as a demonstration of how distinct blacks were. Here, Southerners led the argument that, without forced compulsion, African

Americans would not work efficiently or care for themselves, and would eventually die out. Northerners arrived at the same conclusion, but perceived the disease and criminal behavior they saw as rampant in black communities as constituting a wanton disregard for citizenship and an inability to care for themselves.16

Whites used such racist conclusions not only to explain black ill health, but also as an excuse for not providing more economic and political rights. As the historian Daryl

Michael Scott sums up the situation “…the experts who dominated the image of black people depicted African Americans as incapable and undeserving of participation in modern society.”17 Similarly, historian Michele Mitchell explains “The supposed failure of Reconstruction substantiated social Darwinist claims that, by fiat of biology, black

13 Charles Darwin, The Descent of Man, and Selection in Relation to Sex (London, UK: John Murray, 1871). reprint. New York, NY: Penguin Books, 2004, 163.

14 George Frederickson, The Black Image in the White Mind: The Debate on Afro- American Character and Destiny, 1817-1914 (New York, NY: Harper and Row, 1971), 252.

15 Frederickson, The Black Image in the White Mind, 232; Tera W. Hunter, To ‘Joy My Freedom: Southern Black Women’s Lives and Labors After the Civil War (Cambridge, MA: Harvard University Press, 1997), 186-192; Willoughby, “His Native, Hot Country,”; Washington, Medical Apartheid, 35-38.

16 Frederickson, The Black Image in the White Mind, 236-237, 252-258; Downs, Sick from Freedom, 14-40, 102, 167.

17 Daryl Michael Scott, Contempt and Pity: Social Policy and the Image of the Damaged Black Psyche, 1880-1996, (Chapel Hill, NC: University of North Carolina Press, 1997), xii. 45 people were incapable of reaching the same heights of civilization as ‘Anglo-Saxon,’

‘Alpine,’ and ‘Nordic’ peoples.”18 From the white supremacist perspective, a race that could not care for itself should not receive more opportunities to interact with, and infect, another, supposedly superior, race.

The ease with which some white medical practitioners arrived at black extinction led many to offer either minimal or no medical services to blacks because most physicians conceived of the medical practice as a business. Since poor blacks could not afford medical treatment, and because wealthier blacks spent less money on health than their white colleagues, and would eventually become extinct anyway, physicians had little reason to reach out to, or even treat, black patients. A newly minted doctor’s time seemed better spent on white patients who were more likely to be repeat business and pay their bills.19 By the turn of the century, African American health care choices had begun to shrink as traditional health options became less accepted and the growing number of professional health practitioners saw the black patient as a dying proposition.

The Standardization of the Medical Profession

The standardization of medicine that began during the late nineteenth century gained momentum in the early twentieth century with the rise of white collar middle-class progressives.20 History credits the progressives for movements supporting the franchise

18 Michele Mitchell, Righteous Propagation: African Americans and the Politics of Racial Destiny After Reconstruction (Chapel Hill, NC: The University of North Carolina Press, 2004), 16.

19 James A. Schafer, The Business of Private Medical Practice: Doctors, Specialization and Urban Change in Philadelphia, 1900-1940 (New Brunswick, NJ: Rutgers University Press, 2014), 2-3, 42, 87.

46 for women, prohibition, and child labor laws. To establish the credentials of people who would lead these movements, progressives worked to standardize the professional fields, including medicine.21 By 1900 there were 160 medical schools in the U.S. with a total student body of 25,171. Additionally, hospitals, which had operated more as charities than medical establishments, began to focus on medical practice.22 The growing number of schools combined with the change and expansion of hospital operations and interests to give state licensing boards the ability to set standards for the medical community.

These boards extended the length of medical training and created specific guidelines of practice, increasing costs for those interested in a medical career. Such constraints served to limit the types of people who could train to become doctors while at the same time helping these professionals separate themselves from other health practitioners that competed in the field.23

Such restrictions altered the authority of the physician. During the 1800s, when doctors gave medical advice, patients often treated it as a recommendation rather than a required course of action. With so many competitors in the health field, patients could get

20 Michael McGerr, A Fierce Discontent: The Rise and Fall of the Progressive Movement in America, 1870-1920 (New York, NY: Free Press, 2003), xv-117.

21 A similar standardization process occurred at American universities and colleges throughout the country. See Veysey, The Emergence of the American University, 1865-1915.

22 Starr, The Social Transformation of American Medicine, 112, 25; Morris J. Vogel, “The Transformation of the American Hospital, 1850-1920” in Health Care in America: Essays in Social History, eds. Susan Reverby and David Rosner (Philadelphia, PA: Temple University press, 1979), 106; Harry F. Dowling, City Hospitals: The Undercare of the Underprivileged (Cambridge, MA: Harvard University Press, 1982), especially 63-81; U.S Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970 (Washington, D.C.: U.S. Department of Commerce, 1975), 76.

23 Starr, The Social Transformation of American Medicine 118; Byrd and Clayton, An American Health Dilemma, vol. 1, 376-382. 47 opinions from a variety of people and then make a decision on their own. This gave patients wide latitude in deciding what it meant to be healthy and how to solve health crises. The advent of standardized practices and training along with government supported state licensing boards gave doctors greater authority over the field. By the early

1900s, patients began to hear the words of doctors as commands rather than advice.24 The growing authority of physicians and their expansion from private practice into hospital work came at the same time that insurance companies began to spread across the country.

These companies worked with state licensing boards and doctors to standardize medical treatment, recommendations, and drug use, further enhancing physicians’ power and utility in the eyes of the public.25 In this way, the medical community managed to reinforce the credibility of its own health concepts while undermining those of outsiders.

The medical establishment emphasized the types of tests doctors passed rather than the amount of time spent in practice. Insurance companies encouraged customers to see board certified physicians and nurses, supporting this effort.26 Such cooperation between boards of health and the insurance companies encouraged the public to look to board certified physicians for health explanations.

The new medical establishment also took pains to incorporate scientific theories and statistics into its practice. Germ theory, which attributed disease to specific microorganisms, gradually replaced a person’s particular qualities as the cause of health

24 Starr, The Social Transformation of American Medicine, 13, 24, 118.

25 Starr, The Social Transformation of American Medicine, 24.

26 Annie M. Brainard, The Evolution of Public Health Nursing (Philadelphia: W. B. Saunders, 1922), 304; Nancy Tomes, Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998), 186. 48 issues in the late 1800s.27 The theory emphasized the need for people to see trained physicians who could help them avoid and overcome these small entities. Germ theory also raised the prospect that racial beliefs would no longer factor into medical opinion because specific organisms were the reason for ill health.

Yet, regardless of the research methods used and the perceived higher standards required of those conducting research, white medical elites continued to suggest that

African Americans as well as immigrants from southern and eastern Europe were biologically inferior.28 These opinions carried more weight than ever as more people examined their health and sought out experts to maintain their well-being. Frederick

Hoffman, a statistician for the Prudential Insurance Company of America, offered perhaps the most damning study in his 1896 work Race Traits and Tendencies of the

American Negro, which recommended against insuring blacks.29

Hoffman argued that, as Darwin had asserted, blacks faced extinction. Hoffman’s conclusions relied on statistics from Rhode Island, Connecticut, and Massachusetts that

27 Bonnie Bullough and George Rosen, Preventive Medicine in the United States, 1900- 1990: Trends and Interpretations (Canton, MA: Science History Publications/USA, 1992), 5-6; Charles-Edward Amory Winslow, The Evolution and Significance of the Modern Public Health Campaign (New Haven, CT: Yale University Press, 1923, reprint (South Burlington, VT: Yale University Press, 1984), 53; Anita Calif Fellman and Michael Fellman, Making Sense of Self: Medical Advice Literature in Late Nineteenth-Century America (Philadelphia, PA: University of Pennsylvania Press, 1981), 50; Tomes, Gospel of Germs, 4-6, 28-33.

28 For more on the biological inferiority of white ethnic groups, see for example John Higham, Strangers in the Land: Patterns of American Nativism, 1860-1925 (New Brunswick, NJ: Rutgers University Press, 1955, especially 1-131; Alan M. Kraut, Silent Travelers: Germs, Genes, and the “Immigrant Menace,” (Baltimore, MD: The Johns Hopkins University Press, 1994); Howard L. Markel and Alexandra Minna Stern, “The Foreigness of Germs: The Persistent Association of Immigrants and Disease in American Society,” The Milbank Quarterly 80(4), 2002: 757-788.

29 Frederick L. Hoffman, Race Traits and Tendencies of the American Negro (New York, NY: The Macmillan Company, 1896). The historian James Jones notes that many other insurance companies took up this recommendation. See Jones, Bad Blood, 20. 49 showed that the black population in those states had more deaths than births.30 He found black mortality rates greatest for children and infants, and that blacks generally had weaker organs and an overall poor constitution as compared to whites.31

According to Hoffman, the cause of poor black health outcomes was racial, not environmental. Black “immorality and vice,” which is to say high rates of illegitimate births and venereal diseases, were the prime culprits for poor black health. For Hoffman this meant that “It is not in the conditions of life, but in the race traits and tendencies that we find the causes of the excessive mortality.”32 These “race traits and tendencies” led to

“hereditary transmission of weak constitutions, and to lower still further the rate of natural increase, until the births fall below the deaths, and gradual extinction results.”33

Hoffman realized that some might attribute this conclusion to the researcher’s own racism. However, he asserted that his foreign birth as a native German along with his focus on statistical data made him an unbiased source, giving more weight to his conclusions about African Americans.34

30 Hoffman, Race Traits and Tendencies of the American Negro, 35.

31 Hoffman, Race Traits and Tendencies of the American Negro, 145-148, 66. Other studies at the time supported Hoffman’s conclusions, for example: Harris Seale. “Tuberculosis in the Negro” Journal of the American Medical Association (JAMA) 41 (14) (October 3, 1903): 834- 838; William Z. Ripley, The Races of Europe: A Sociological Study (New York, NY: D. Appleton & Company, 1899), 564-566.

32 Hoffman, Race Traits and Tendencies of the American Negro, 95. Italics in the original.

33 Hoffman, Race Traits and Tendencies of the American Negro, 95. All of Hoffman’s conclusions were based on cherry-picking statistics. The U.S. census did not back up his findings. This issue will be addressed in the pages that follow.

34 Hoffman, Race Traits and Tendencies of the American Negro, v; Samuel Kelton Roberts, Jr., Infectious Fear: Politics, Disease, and the Health Effects of Segregation (Chapel Hill, NC: University of North Carolina Press, 2009), 49-50. For a discussion of nature as the reason for black weakness, depravity, and affinity towards disease, see William P. Calhoun The Caucasian and the Negro in the United States. They must Separate. If Not, Then Extermination. A Proposed 50

In addition to condemning African Americans to extinction, Hoffman supported the arguments regarding the benefits of slavery. Without specific statistics he declared, “…all the data at my command show that physically the race [during slavery] was superior to the present generation….”35 Hoffman argued that not only had advances in medical care seemingly not made a dent in helping African Americans, but also that the race was actually worse off than before. Essentially, he argued that blacks were succumbing to freedom.

In addition to absolving whites of any blame for poor black health, Hoffman also encouraged them not to help blacks improve their situation. “Instead of clamoring for aid and assistance from the white race the negro himself should sternly refuse every offer of direct interference in his own evolution. The more difficult his upward struggle, the more enduring will be the qualities developed.”36 This conclusion gave white health professionals, already reluctant to provide health services to blacks, permission to essentially ignore the race and continue racist practices that directly contributed to poor black health.37

Thus, Hoffman’s work not only condemned African Americans to extinction and excused white medical neglect, it also supported segregation. Hoffman’s finding that high

Solution: Colonization (Columbia, SC: The R. L. Bryan Company, 1901), especially 20-22. Others believed Hoffman’s assertion that his foreign birth prevented him from having bias. See Smith, The Color Line, 194.

35 Hoffman, Race Traits and Tendencies of the American Negro, 236.

36 Hoffman, Race Traits and Tendencies of the American Negro, 328. Hoffman was not alone here. See also William Benjamin Smith, The Color Line: A Brief in Behalf of the Unborn (New York, NY: McClure, Phillips & Co., 1905), 188.

37 Muhammad, The Condemnation of Blackness, 41. 51 rates of black disease and death had to do with inherent racial characteristics that only blacks could alter implied that a “solution” to poor black health was to separate them from “healthy” society. Indeed, a common practice was to isolate populations, particularly poor white ethnic minorities and blacks, from others during a disease outbreak.38 However, Hoffman’s work combined with others to encourage health practitioners to take these confinements one step further. Baltimore physician William

Lee Howard argued that “There is every prospect of checking and reducing these diseases

[sexually transmitted diseases] in the white race, if the race is socially – in every aspect of the term – quarantined from the African.”39 Howard’s racist conclusion, based on no evidence, suggested that only blacks were capable of transmitting these diseases. Such racist thinking helped spur Baltimore, the city with the fifth largest black population in the country, to enact the first law in the U.S. prohibiting blacks from moving to white residential blocks.40

Yet segregation as a medical solution was problematic given that many blacks worked as domestic servants in white households. In 1910 Philadelphia, 87.8% of all black female laborers worked in white residences.41 Nationally, from 1890-1930, 34% of all servants were black.42 This situation meant that if one accepted Hoffman’s

38 Michael Willrich, Pox: An American History (New York, NY: The Penguin Press, 2011), 54-212.

39 William Lee Howard, “The Negro as a Distinct Ethnic Factor in Civilization,” Medicine 60 (May, 1903), 424.

40 Antero Pietila, Not in My Neighborhood: How Bigotry Shaped a Great American City (Chicago, IL: Ivan R. Dee, 2010), x-52.

41 David McBride, Integrating the City of Medicine: Blacks, in Philadelphia health Care, 1910-1965 (Philadelphia, PA: Temple University press, 1989), 12.

52 conclusions, blacks posed a major threat to white health even as whites relied on blacks to support white health and wellbeing.43

The Du Bois’ Response

African Americans did not simply acquiesce to pronouncements of their demise and the supposed threat they posed to whites. Indeed they could not since, as the historian

Michele Mitchell puts it, “Rampant allegations that the race was inherently lascivious and degenerate were anything but benign: such allegations rationalized lynching and ritualized rape, legitimated segregation, and restricted employment opportunities.”44 With so much riding on these characterizations of the race, W.E.B. Du Bois, a recently appointed professor at Atlanta University, led the black defense with his 1897 review of

Hoffman’s work. Here Du Bois argued that the 1890 census, which Hoffman based his work on, was inaccurate and undercounted African Americans, particularly in the South.

This undercount made it look like the black birth rate and population had decreased when they had not.45

42 St. Clair Drake and Horace R. Cayton, Black Metropolis: A Study of Negro Life in a Northern City (New York, NY: Harcourt, Brace and Company, 1945), 219; Schafer, The Business of Private Medical Practice, 76-86; Hunter, To ‘Joy My Freedom, 105-106.

43 Hunter, To ‘Joy My Freedom, 105-106.

44 Mitchell, Righteous Propagation, 11.

45 W.E.B. Du Bois, “Review of Hoffman’s Race Traits and Tendencies of the American Negro,” Annals of the American Academy of Political and Social Science 9:1 (1897), 128; Frederickson, The Black Image in the White Mind, 245-247; Roberts, Jr., Infectious Fear, 50-51. Roberts Jr., notes that part of the issue had to do with the location of the census, which mostly used data gathered in cities instead of rural areas in which the vast majority of the black population lived during this time. See Karl E. Taeuber and Alma F. Taeuber, “The Negro Population in the United States,” in The American Negro Reference Book, ed. John P. Davis (Englewood Cliffs, NJ: Prentice-Hall, Inc., 1966): 96-160, 122. 53

Getting more specific in his critique, Du Bois asserted that Hoffman chose certain statistics to make his case for African American extinction. As Du Bois explained,

Hoffman based his extinction hypothesis on data gathered from cities, which statisticians had only recently collected and could not compare to past studies. Furthermore, such statistics meant that Hoffman ignored the vast majority of African Americans who lived in the rural South.46 Since Hoffman’s data focused on a small minority of the black population, it served as an insufficient basis to build his argument. Yet even if one accepted Hoffman’s data, Du Bois pointed out that, “Montreal, Naples, Belfast,

Budapesth[sic], Breslau and Madrid, all have shown within a few years, death-rates which equal and often surpass that of American Negroes in cities.”47 No statistician would argue that the white European race faced extinction, so Hoffman’s conclusion, based on similar evidence, had to be incorrect.

Du Bois’ biggest concern was Hoffman’s attribution of the high black death rate to inherent racial traits instead of to the environmental conditions that blacks faced.48 Du

Bois’ 1899 study of Philadelphia’s black community, The Philadelphia Negro, examined this issue in more depth. He found that “Negroes as a class dwell in the most unhealthful parts of the city and in the worst houses in those parts….”49 While he recognized that

46 Du Bois, “Review of Hoffman’s Race Traits and Tendencies of the American Negro,” 128-130.

47 Du Bois, “Review of Hoffman’s Race Traits and Tendencies of the American Negro,” 130. Du Bois made a similar argument in The Philadelphia Negro; A Social Study (Philadelphia, PA: University of Pennsylvania, 1899), 150, where he notes that between 1871 and 1890 the average death rates of Hungary, Austria and Italy were greater than those of blacks.

48 Du Bois, “Review of Hoffman’s Race Traits and Tendencies of the American Negro,” 127.

49 Du Bois, The Philadelphia Negro, 148. 54 blacks had a higher death rate than whites, Du Bois attributed this to “Bad ventilation, lack of outdoor life for women and children, poor protection against dampness and cold….”50 In Philadelphia’s seventh ward, only 14% of families had bathrooms and as many as 20% had no private outhouse.51 As Du Bois explained, African Americans had higher death rates because they lived in poor conditions that prevented them from practicing proper health, not because of some inherent racial trait. Indeed, Du Bois found that those few African Americans who maintained clean homes had significantly lower death rates than other members of the race.52 He later concluded that with “improved sanitary condition, improved education and better economic opportunities, the mortality of the race may and probably will steadily decrease until it becomes normal.”53 For Du

Bois, proper health encompassed economic and political rights. Improvement in one would help all and restricting one limited all.

Some results of Du Bois’ research were similar to Hoffman’s. Both identified black ignorance of proper health practices as a contributing factor to the group’s high death rate. Whereas Hoffman looked at the effects of feeding items, such as castor oil, to infants, Du Bois’ research contradicted the earlier emphasis on the positives of slavery for African American health.54 Du Bois argued that “The Southern field-hand was hardly

50 Du Bois, The Philadelphia Negro, 152.

51 Du Bois, The Philadelphia Negro, 161.

52 Du Bois, The Philadelphia Negro, 150.

53 W.E.B. Du Bois, ed., The Health and Physique of the Negro American, Report of a Social Study made under the direction of Atlanta University, on May the 29th, 1906 (Atlanta, GA: The Atlanta University Press, 1906), 90.

54 Hoffman, Race Traits and Tendencies of the American Negro, 63. 55 supposed to wash himself regularly, and the house-servants were none too clean.”55

African Americans continued to practice these unhealthy habits after slavery.

Another topic on which Hoffman and Du Bois agreed concerned black disinterest in medical advice.56 Whereas Hoffman perceived this apathy as a character flaw inherent to the race, Du Bois placed it in the context of poor people generally. As discussed earlier, prior to the 1880s, hospitals acted as charities, focusing on treating the poor for minor maladies. As historian Morris J. Vogel explains, this concept led to “institutions in which the patient was often secondary to the wellbeing of the society that required his isolation.”57 Administrators looked down on patients for being sick and associated ill health with patient transgression, a punishment for bad behavior.58 Along with administrators scolding patients for their deviant ways, these early hospitals contained a variety of diseases. Patients often stayed in close quarters, risking infecting each other, and improper sanitation raised the prospect of sepsis infections.59 In addition to these issues, experienced by patients of all races, African Americans who went to hospitals and sanitariums faced discrimination from both officials and patients. Such treatment contributed to the higher death rates blacks had at these institutions and left African

Americans feeling that doctors and nurses could not treat black illnesses.60

55 Du Bois, The Philadelphia Negro, 161.

56 Hoffman, Race Traits and Tendencies of the American Negro, 63.

57 Vogel, “The Transformation of the American Hospital,” 106.

58 Fanning, Influenza and Inequality, 6-7; Barbara Bates, Bargaining for Life: A Social History of Tuberculosis, 1876-1938 (Philadelphia, PA: University of Pennsylvania Press, 1992), 291; Dowling, City Hospitals, especially 81.

59 Vogel, “The Transformation of the American Hospital,” 106.

Due to the increased standardization of the medical profession, hospitals began to focus more on generating wealth than serving the destitute, especially as the middle-class began to turn to these institutions for treatment.61 Hospitals upgraded their facilities and staff and reduced or eliminated free services because middle-class patients could pay for them. Many also responded to the progressive impulse to separate the races, creating segregated areas or restricting African Americans from getting treatment.62 While the number of hospitals increased from 178 in 1873 to 4,359 in 1909, there were only 63 exclusively black institutions by 1912, meaning that most blacks did not have hospital access.63 Furthermore, as Vogel explains, “the admissions process [of hospitals] often worked to exclude the potentially deviant, those from whom society thought it had the most to fear.”64 Hospitals quickly became yet another medical institution where African

Americans found themselves facing rampant discrimination, segregation, and abuse.

60 Bates, Bargaining for Life, 293-296; Darlene Clark Hine, Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890-1950 (Bloomington, IN: Indiana University Press, 1989), 22; McBride, Integrating the City of Medicine, 80-81.

61 Vogel, “The Transformation of the American Hospital” 105-110; David Rosner, “Business at the Bedside: Health Care in Brooklyn, 1890-1915,” in Susan Reverby and David Rosner, eds. Health Care in America: Essays in Social History (Philadelphia, PA: Temple University Press, 1979), 122-125.

62 For more on segregation’s role in progressivism, see McGerr, A Fierce Discontent, 182-220.

63 Susan Reverby, “The Search for the Hospital yardstick: Nursing and the Rationalization of Hospital Work,” in Susan Reverby and David Rosner, eds. Health Care in America: Essays in Social History (Philadelphia, PA: Temple University Press, 1979), 207-208; W. Michael Byrd and Linda A. Clayton, An American Health Dilemma: A Medical History of African Americans and the Problem of Race, vol. 2 (New York: Routledge, 2002), 54; Vanessa Northington Gamble, “Roots of the Black Hospital Reform Movement,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, ed. Judith W. Leavitt and Ronald L. Numbers, 3rd ed. (Madison, WI: University of Wisconsin Press, 1997), 384. The 63 black institutions include black hospitals and black nurse training schools.

64 Vogel, “The Transformation of the American Hospital,” 107. 57

Physician practices also fomented black mistrust of medical advice. Many doctors handled poor patients in an aggressive manner. One of the most common examples concerned vaccination. Rather than explaining the necessity of vaccines, health officials worked with businesses to make it a requirement of employment. During an outbreak, police escorted health professionals into the homes of the impoverished and forced vaccinations on those who resisted.65 Such behavior created distrust between those most in need of medical treatment and physicians. The issue became much more contentious when Camden and St. Louis reported deaths from vaccines in 1901 and 1902.66

While forced vaccinations were also a problem for poor whites and immigrants, the racism that African Americans faced on a regular basis compounded the impact of these heavy-handed tactics. Du Bois noted that the entire treatment experience created a black population in which “many a Negro would almost rather die than trust himself to a hospital,” or indeed any medical institution.67 Black suspicion and fear of professional medical care, what the historian Harriet A. Washington calls “iatrophobia,” had little to do with racial traits.68 Given their long history of dealing with the inherent racism, deception, and malpractice so evident among white medical practitioners, African

Americans were reluctant to seek their advice or care.

65 Willrich, Pox, 5-7, 47-100; Du Bois, The Philadelphia Negro, 162; Downs, Sick from Freedom, 102-111; Hunter, To ‘Joy My Freedom, 205.

66 Willrich, Pox, 167-170.

67 Du Bois, The Philadelphia Negro, 162; Bates, Bargaining for Life, 291.

68 Washington, Medical Apartheid, 47. Her book documents a variety of risky and painful medical experiments white physicians conducted on African American patients without their consent or full understanding of the procedure. 58

In perhaps the most surprising point of agreement between the two, both Hoffman and Du Bois asserted that the best way for African Americans to improve their health was to take control of their health practices. However, Hoffman and Du Bois disagreed about what this meant. For Hoffman, it meant reducing the philanthropy whites gave to blacks.

He felt charity infantilized blacks and reduced their drive for self-help.69

Du Bois focused on the empowerment blacks would have over their own health without white philanthropy’s influence. An emphasis on proper food, fresh air, and cleanliness would utilize modern health concepts to reduce the black death rate.70 Such a decrease would demonstrate that environmental and social conditions altered black life expectancy, not inherent racial traits. Thus, he hoped that others would come to his conclusion “That the Negro death-rate at present is anything that threatens the extinction of the race is either the bugbear of the untrained, or the wish of the timid.”71

Yet Du Bois’ challenge to Hoffman gained little traction, most likely because society inculcated most whites with negative views towards African Americans from birth to death. Indeed the increasingly organized and esteemed white medical establishment conducted a wealth of studies that reinforced ideas about inherent racial differences in health. Much of this research appeared in the Journal of the American Medical

Association (JAMA), the most widely read and respected health periodical of its time and run by an organization that permitted its affiliates to discriminate based on race.72

69 Hoffman, Race Traits and Tendencies of the American Negro, 241-242.

70 Du Bois, The Philadelphia Negro, 162-3.

71 Du Bois, The Philadelphia Negro, 163.

Dr. Thomas Murrell’s 1910 JAMA article provides a good example of the type of racism the American Medical Association (AMA) perpetuated. He examined the perception of African American well-being during slavery and the group’s subsequent inherent illness and lack of sophistication in contemporary times. Like, Hoffman, Murrell attributed the decline he found in the black population after 1860 to emancipation and not data collection errors. After emancipation, Murrell argued that the increased freedom

African Americans had led not only to deteriorating health practices, but also to drinking and an increased sexual appetite.73

Sexual appetite became a topic of particular investigation. Medical professionals debated at what age they might still be able to find an African American female virgin.74

Murrell went even further, asserting that “A negro man will not abstain from sexual intercourse if there is the opportunity and no mechanical obstruction.”75 Instead of looking for ways to improve African American health, medical professionals sought evidence to support preconceived racist tropes about voracious and uncontrollable black sexual desires. Their work, printed in the leading medical journals, contributed further to

72 For more on the AMA’s racial discrimination, see Robert B. Baker, Harriet A. Washington, Ololade Olakanmi, Todd L. Savitt, Elizabeth A. Jacobs, Eddie Hoover, Matthew K. Wynia, “African American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide,” JAMA 300(3) 2008: 306-314.

73 Thomas W. Murrell, “Syphilis and the American Negro: A Medico-Sociologic Study,” JAMA 54(11) 1910: 847; H. H. Hazen, “Syphilis in the American Negro,” JAMA 63(6) 1914: 463- 466, 463; L.C. Allen, “The Negro Health Problem,” American Journal of Public Health (AJPH) 5 (March) 1915: 194-203, 194-6; Seale, “Tuberculosis in the Negro,” 834-838; Theophilus O. Powell, “The Increase of Insanity and Tuberculosis in the Southern Negro Since 1860, and Its Alliance, and Some of the Supposed Causes,” JAMA 27(23) 1896: 1185-1188.

74 Murrell, “Syphilis and the American Negro,” 847; Hazen, “Syphilis in the American Negro,” 463; Daniel D. Quillian, “Racial Peculiarities as a Cause of the Prevalence of Syphilis in Negroes,” Medical Ear (St. Louis), 1911, xx, 416; American Journal of Dermatology and Genito- Urinary Diseases, 1906, x, 277.

75 Murrell, “Syphilis and the American Negro,” 847. 60 the perception that blacks needed whites to oversee black health. For example, U.S.

Army policies at several camps required black soldiers returning from leave to go through chemical prophylaxis.76

Doctor L.C. Allen took the concerns about black sexual promiscuity to their logical conclusion, writing that “If the spread of syphilis, gonorrhea and tuberculosis among the

American negro[sic] is not checked, this once physically superb race will become extinct with a few generations.”77 Allen’s affirmation of Hoffman’s earlier work illustrates the historian James Jones’ summation of the content of medical articles on blacks at the turn of the century, which portrayed “…a race whose members were rapidly becoming diseased, debilitated, and debauched, and had only themselves to blame.”78 In short, physicians and health experts continued to tie perceptions and beliefs about race to prognostications about the future, or lack thereof, for African Americans.

Perhaps even more significant than the rote way of supporting racist beliefs and discriminatory practices was the medical establishment’s acceptance of the situation. At the turn of the century, the leading causes of death were influenza, pneumonia, tuberculosis, and gastrointestinal infections.79 Blacks died at a higher rate than whites for all these diseases and had a death rate for tuberculosis that was three times greater than that of whites and two times greater for pneumonia.80 Although, as Chapter 3 will

76 Jones, Bad Blood, 25-28; John Parascandola,, Sex, Sin, and Science: A History of Syphilis in America (Westport, CT: Praeger, 2008), 38-39, 68.

77 Allen, “The Negro Health Problem,” 197.

78 Jones, Bad Blood, 21.

79 Bullough and Rosen, Preventive Medicine in the United States, 1900-1990, 4.

61 discuss, physicians organized many programs to improve white health outcomes, the racist beliefs about black inferiority and limited intelligence led white physicians to suggest that nothing could be done to help blacks.81 According to Murrell, “Teaching him

[blacks] the hygiene of the disease is so hopeless that when we instruct him it would be a farce were it not a tragedy.”82 Similarly, Allen interviewed an unnamed physician who said “You might as well try to teach sanitation to mules as to try to teach it to the negroes.”83 For Murrell and others, blacks simply did not have the capacity to understand concepts of disease, infection, and treatment.

Many physicians ignored the discriminatory practices that created their perceptions.

They overlooked the lack of public services available to African Americans, such as garbage removal, sewage systems, or running water. Also left undiscussed were issues of race that made it difficult for blacks to improve their socioeconomic status, not to mention the scant medical services available to African Americans. The white medical

80 McBride, From TB to AIDS, 11; Edward H. Beardsley, A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South (Knoxville, TN: University of Tennessee Press, 1987), 13; Linda O. McMurry, Recorder of the Black Experience: A Biography of Monroe Nathan Work (Baton Rouge, LA: Louisiana State University Press, 1984), 111; Monroe N. Work, Negro Year Book and Annual Encyclopedia of the Negro, 1912 (Nashville, TN: Sunday School Union Print, 1912), 152-155; Monroe N. Work, Negro Year Book and Annual Encyclopedia of the Negro, 1913 (Tuskegee, AL: Negro Year Book Co., 1913), 245-247; Allen, “The Negro Health Problem,” 197. As Keith Wailoo has pointed out, a notable exception to the general understanding that blacks were more susceptible to disease than whites was cancer. See Keith Wailoo, How Cancer Crossed the Color Line (New York, NY: Oxford University Press, 2011).

81 See John Ettling, The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South (Cambridge, MA: Harvard University Press, 1981). For tuberculosis see Michael E. Teller, The Tuberculosis Movement: A Public Health Campaign in the Progressive Era (New York, NY: Greenwood Press, 1988).

82 Murrell, “Syphilis and the American Negro,” 848.

83 Allen, “The Negro Health Problem,” 201. Allen thought the only way to educate blacks about health was to discuss the topic with them in very small groups or clubs, 202. 62 establishment’s racist beliefs about black inferiority led doctors to debate the utility of providing blacks with even the most basic of health education, such as lectures on disease and sex.84

Black Physicians and the White Medical Establishment

With the preconceived notions of white physicians influencing their practice, the

African American physician was a logical person for blacks to turn to for health improvement. However, the few African Americans able to overcome the rampant racial discrimination to become physicians faced significant obstacles in attempting to improve the race’s health. One problem was their numbers. There were only 3,409 black doctors in 1910, or 2.5% of all physicians.85 Having so few health professionals made it difficult to meet the race’s needs. Another problem was obtaining patients. The mistreatment many African Americans had at the hands of medical institutions made them wary of seeing health professionals, black or white. African American physicians had to convince the race that black doctors could be trusted with health concerns. A third problem was

84 While Hazen argued that blacks were incapable of understanding sex lectures, Allen thought that the only way to improve black health was to lecture blacks in small groups. Hazen, “Syphilis in the American Negro,” 465; Allen, “The Negro Health Problem,” 202. See also Parascandola, Sex, Sin, and Science, 159-168.

85 Most historians use this 3,409 number, which comes from W. Montague Cobb, “Progress and Portents for the Negro in Medicine,” The Crisis April 1948: 107-122, 108. See for example Byrd and Clayton, An American Health Dilemma, vol. 1, 384, 398; David McBride, Caring for Equality: A History of African American Health and Healthcare (Lanham, MD: Rowman & Littlefield, 2018), 66. The total number of doctors was 135,000, see U.S. Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970, Part 1 (Washington, D.C.: U.S. Government Printing Office, 1975), 76. The U.S. Census for 1910 only recorded 2,744 black physicians, but there were errors in the data collection and changes in classifications that affected its figures. See U.S. Bureau of the Census, Sixteenth Census of the United States: 1940 – Population: Comparative Occupation Statistics for the United States, 1870 to 1940 (Washington, D.C.: U.S. Department of Commerce, 1943), 157, 165. 63 that African American physicians lacked respect. As the historian Gretchen Long explains, “In popular culture, African American doctors were objects of amusement,” and caricatures of them as clumsy or incompetent abounded.86

Among their white colleagues, black doctors continued to face discrimination as they practiced. The American Medical Association (AMA) allowed local affiliates wide latitude to decide what credentials physicians needed to become members, including skin tone. Shut out from white professional medical associations, African Americans established their own organization, the National Medical Association (NMA) in 1895, which had no racial restrictions.87

The Flexner Report in 1910 introduced another blockade to the acceptance and training of African American physicians. Traveling with the secretary of the AMA’s

Council on Medical Education, Abraham Flexner, an expert on higher education, examined more than 155 medical schools in the U.S. and Canada to assess the education and practices of doctors. He found many medical schools lacking in terms of their facilities, the education required of their applicants, and the training provided to students.

His findings contributed to the closing or merging of 48 schools between 1909 and

1915.88 Perhaps more significantly, as historian E. Richard Brown explains, the report

86 Gretchen Long, Doctoring Freedom: The Politics of African American medical Care in Slavery and Emancipation (Chapel Hill, NC: The University of North Carolina Press, 2012), 168.

87 This segregation from many of the AMA’s state affiliates was not the only reason for the NMA’s creation. Another was to foster medical professional unity and support the profession as a whole. See Todd L. Savitt, “The Journal of the National Medical Association 100 Years Ago: A New Voice of and for African American Physicians,” Journal of the National Medical Association (JNMA) 102(8) 2010: 734-744, 734-739.

88 E. Richard Brown, “He Who Pays the Piper: Foundations, the Medical Profession, and Medical Education,” in Health Care in America: Essays in Social History, eds. Susan Reverby and David Rosner (Philadelphia, PA: Temple University Press, 1979), 133-134. Gerald E. Markowitz 64

“helped ‘educate’ the public to accept scientific medicine…”89 Flexner articulated the ideal skills and expertise that physicians should have. This explanation established the differences between orthodox doctors and others, such as homeopaths, folk healers, and even nurses, making it clear why the public should consult physicians for health advice.

Regarding African American health, Flexner’s Report reinforced concepts of black inferiority and the superiority of whites and their interests. Although he argued that any improvement “must be done largely by the negro doctor and the negro nurse,” he maintained that, “The medical care of the negro race will never be wholly left to negro physicians.”90 While Flexner acknowledged the need for African American health professionals as the best conduit to work with black patients, he suggested that whites still needed to be involved in black health care. Here he implied that white physicians knew better than their black counterparts. If the two had equal knowledge, then black doctors could be “left to” to care for their own race.91 Additionally, Flexner argued that black health problems were important within the context of white health, “The negro[sic] must be educated [in medicine] not only for his sake, but for ours.”92

and David Rosner note that the AMA began the process of closing and merging schools, see Gerald E. Markowitz and David Rosner, “Doctors in crisis: Medical Education and Reform During the Progressive Era, 1895-1915,” in Health Care in America: Essays in Social History, eds. Susan Reverby and David Rosner (Philadelphia, PA: Temple University Press, 1979), 190-196; Starr, The Social Transformation of American Medicine, 119-123.

89 Brown, “He Who Pays the Piper,” in Reverby and Rosner, eds. Health Care in America, 134.

90 Abraham Flexner, Medical Education in the United States and Canada (D.B. Updike, The Merrymount Press, Boston 1910), 180.

91 In addition to Flexner, the historian Barabara Bates found a similar belief among white medical profssionals that their black colleagues required white direction. See Bates, Bargaining for Life, 296-392.

Problematically, he found the training at black medical institutions wanting. Of the seven medical schools available to blacks at the time, “five are at this moment in no position to make any contribution of value.”93 Only two, Meharry Medical College in

Nashville and Howard University in Washington, D.C., met the standards the white medical profession set.94 Percentage wise, the five problematic black schools far exceeded the percentage of problematic white schools. Flexner recommended the rest shut down, which they eventually did as financial support dried up, at least in part due to his Report.95 Thus, the Flexner Report perpetuated the practice of limiting the opportunities blacks had to learn the craft of medicine even as it absolved whites of any blame.96 Flexner never critiqued the discrimination that denied blacks entrance to most medical schools. His Report omitted a discussion of the reasons why black medical schools had scant resources and how the lack of local white medical support impacted their ability to educate students and provide them with learning opportunities.97

92 Flexner, Medical Education in the United States and Canada, 180.

93 Flexner, Medical Education, 180.

94 The others at the time: 1) Flint Medical College in New Orleans; 2) Leonard Medical School in Raleigh; 3) Knoxville Medical College in Knoxville; 4) Medical Department of the University of West Tennessee in Tennessee; 5) National Medical College in Louisville.

95 Earl H. Harley, “the Forgotten History of Defunct Black Medical Schools in the 19th and 20th Centuries and the Impact of the Flexner Report,” JNMA 98(9) 2006: 1425-1429. Harley notes that the ties between school closings and financial support related to the Flexner report were particularly true for Leonard Medical School and National Medical College, see 1427-1428.

96 Flexner, Medical Education in the United States and Canada, 180-181; Louis W. Sullivan and Ilana Suez Mittman, “The State of Diversity in the Health Professions a Century After Flexner,” Academic Medicine 85(2) 2010: 246.

97 See for example “Report of Committee on medical Education on Colored Hospitals,” JNMA 2(4) 1910: 283-291. 66

While Flexner’s Report indicated that African Americans could become doctors, his attack on black medical schools implied that few blacks had the qualifications to hold the title of physician. Flexner went on to suggest that African Americans interested in medicine lower their ambitions. He asserted that a suitable black medical education should focus on “hygiene rather than surgery” and suggested that schools focus on sanitation.98 His assessments supported white beliefs about poor black intelligence and the general inferiority of blacks. The Report made white physicians and nurses even more skeptical of the abilities of their African American counterparts.99 It also permitted medical organizations to use medical education, not race, as the reason for excluding blacks from membership. Without the support of a local medical group, black doctors could not continue their medical education, leaving many unable to improve their skills.100

The atmosphere of medical establishment sanctioned racism in the training and practice of medicine led the majority of African American physicians to challenge the black medical outlook. These doctors used several different strategies, the first and most prevalent of which was to demonstrate their medical expertise. In addition to simply practicing medicine and treating patients, the nascent NMA launched its own medical journal in 1909, which included instructional articles and public health studies. The historian Todd L. Savitt explains that part of the reason for this focus on medical topics was because the editors of the Journal of the National Medical Association (JNMA)

98 Flexner, Medical Education, 180.

99 Hine, Black Women in White, 98.

100 Byrd and Clayton, An American Health Dilemma, vol. 1, 401. 67

“understood that the black medical profession was being watched because it was comprised of people who in the past whites had considered inferior and not expected to succeed.”101 These articles in JNMA were similar to those in JAMA and meant to emphasize the quality of the work black doctors provided and unify medical practices.102

A second method occurred primarily in the pages of the JNMA. According to Savitt, the JNMA provided a forum for black doctors to “firmly respond to the negative articles and biased, even hateful attitudes expressed by white medical and lay people.”103 The

JNMA’s editor, C. V. Roman, a graduate of Meharry Medical College, was often the one to take on this challenge. In response to Murrell’s JAMA article on syphilis, he did not mince words in calling attention to the racist beliefs underpinning Murrell’s work. He accused Murrell of having a disease, “dementia Americana,” that caused him to arrive at his incorrect conclusions. The symptoms of this disease were, “Stigmatizing as peculiar

Negro vices, frailties that are universal and human,” and “The contention that there is neither intelligence nor morality in the Negro.”104

Roman was careful not to go too far in his attack. He noted his own dislike of sexually active unmarried black women in an attempt to separate himself from other so- called “race defenders.” In acknowledging concerns about certain black behaviors,

101 Todd L. Savitt, “The Journal of the National Medical Association 100 Years Ago,” 742.

102 Long, Doctoring Freedom, 168-169; McBride, From TB to AIDS, 22-23; Todd L. Savitt, Race and Medicine in Nineteenth – and Early-Twentieth-Century America (Kent, Ohio: The Kent State University Press, 2007), 270-275; Byrd and Clayton, An American Health Dilemma, vol. 1, 376.

103 Savitt, “The Journal of the National Medical Association,” 736.

104 “Seeing Red,” JNMA 2(2) 1910: 104-106, 105. Although not specifically credited with writing this article, Roman was the editor of JNMA and historians have given him credit for most editorials in the Journal during this time. See Savitt, “The Journal of the National Medical Association,” 734-744. 68

Roman attempted to assert the ability of black physicians to assess the health needs and concerns of their race. Roman argued that Murrell based his conclusion on Murrell’s exposure to women of loose sexual habits who used the free clinic where he worked.

Roman explained that these women did not represent the average black woman. Here again, he attacked the use of racist and limited evidence to condemn African Americans.

Roman also used the JNMA to reinforce the point that African American health problems were not unique. He ended his critique noting that “Poverty, disease and crime are not however, race problems, but human problems.”105 Elsewhere he argued that

“Poverty, idleness, injustice, immorality, ignorance and disease are problems that vex society everywhere, and the effort to make them appear as peculiar phases of the race question in the South is both inaccurate and unjust.”106 Here Roman made the same argument Du Bois had years earlier. Both agreed that rather than racial traits, it was socioeconomic and environmental factors, due in no small part to racist practices, that primarily caused African American ill health.

Black doctors also asserted that the conclusions white physicians drew about black ill health had a negative impact on the white population. Dr. Edward Boyle took on the issue of how medical schools taught black health. In the JNMA, he argued against instruction that portrayed blacks as having fundamental vulnerability to infectious disease. Boyle stated that this premise would make white doctors reluctant to provide aid due to the perception that the physician had little chance of curing the patient. Boyle posited that these practices affected whites in significant ways. Since blacks in urban areas often had

105 “Seeing Red,” JNMA 2(2) (Apr-Jun, 1910): 106.

106 “Art Thou in Health, My Brother?” JNMA 1(2) 1909: 107-108, 108. 69 jobs as domestic workers in white homes, working as cooks, cleaners, and even nurses for children, untreated blacks had the potential to infect their white employers.107

One other method African American physicians used to improve the black medical outlook was to suggest actions that the whole race could take to uplift themselves. This method grew in importance as health data became more available and continued to assert that African American health was in dire straits. While the crude death rate in the U.S. in

1900 was 17.2 deaths per 1000 people, statisticians found that African Americans died at a rate of 25 per 1000. Additionally, the average life expectancy in America in 1900 was

47 years, but even in 1913, that of African Americans was only 33.108 Charles Roman proposed that African Americans practice a modified version of vegetarianism and abstain from alcohol.109 This solution fit within the white progressive effort to prohibit alcohol, suggesting that the health concerns of the races were not that different. Many whites and African American elites thought alcohol contributed to prostitution and other elicit behaviors, and even disease.110 Roman’s proposal thus carved out a place for whites to support black health.

Yet Roman argued that African Americans needed more than just a health plan to improve their health and urged the federal and state governments to distribute public

107 Edward Mayfield Boyle, “A Comparative Physical Study of the Negro,” JNMA 4(2) 1912: 125-8.

108 U.S Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970 (Washington, D.C.: U.S. Department of Commerce, 1975), 55; Bullough and Rosen, Preventive Medicine in the United States, 1900-1990, 3; John W. Ward and Christian Warren eds., Silent Victories: The History and Practice of Public Health in Twentieth-Century America (New York, NY: Oxford University Press, 2007), V; McBride, From TB to AIDS, 11; McMurry, Recorder of the Black Experience, 111.

109 Charles V. Roman, “A Preventable Death Rate,” JNMA 7(2) 1915: 88-95, 94.

110 Mitchell, Righteous Propagation, 112-117. 70 health money more evenly across the population.111 This solution emphasized the idea that blacks could improve their own condition. Here too he felt he could rely on white health officials for support because he wanted access based on need, not race. As the white doctor L.C. Allen argued earlier that year, the poor, both black and white, faced the issues of “filth and contagion, coupled with ignorance and indifference, [which] always bring about disease and death.”112 Roman carefully put his paper in dialogue with other white health practitioners at the time to ensure that the entire health community would see the merits, and competency of his work. He concluded by agreeing with both

Hoffman and Du Bois that “the ultimate salvation of a race depends upon its ability to evolve guides of its own blood…”113 African Americans had to implement the changes and improvements to aid their own race, hence the need for improved black medical schools, hospitals, and public health education.

By the early twentieth century, what constituted a physician had become clearer. The medical establishment created tests and other standards that medical professionals had to meet and made qualifications clear to the public. In doing so, the medical elite connected proper health with seeing a doctor. Only a trained medical practitioner could declare a person healthy, as only the doctor had the training necessary to understand health’s intricacies.

Standardizing proper health in this way made it difficult for African Americans to understand and obtain it. While doctors relied more on data and germ theory, their use of

111 Roman, “A Preventable Death Rate,” 94.

112 Allen, “The Negro Health Problem,” 199.

113 Roman, “A Preventable Death Rate,” 95. 71 these new practices served to reinforce perceptions that African Americans were, as the historian Keith Wailoo puts it, “a naturally diseased people.”114 Since the medical establishment decided who had proper health, such condemnations carried great weight and reinforced the existing negative public opinion toward blacks. While Du Bois and the

NMA argued against this negative perception, they had trouble gaining traction, due in large measure to the widespread dissemination and acceptance by most whites of spurious white racist views regarding black people.115 Those who saw hope for the race argued that African Americans themselves had to take the initiative to improve their health. However, the question remained as to what such a plan to improve black health might look like, and who would lead it.

Starting Small – Monroe Work and the Men’s Sunday Club in Savannah

Although Du Bois and some black physicians challenged white conclusions about black health, few individuals attempted to galvanize their communities around the subject. Some fraternal organizations hired a physician to cater to the needs of members, giving some in the black working class access to “proper” medical care such as that their

114 Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill, NC: The University of North Carolina Press, 1997), 56.

115 Herbert Morais, The History of the Negro in Medicine (New York, NY: Publishers Company, 1967), 68.

72 white fraternal counterparts enjoyed.116 Women’s groups also worked on health issues, raising funds for hospitals and other projects.117

However, the scant number of programs served relatively few African Americans.

One had to be a dues-paying member of an organization to access its resources and women’s groups mostly focused on local health issues. Black churches, a powerful influence in the lives of most African Americans, advocated health education from time- to-time, but they did not maintain this focus for long periods. Additionally, most black institutions faced constant worries about funding, often pushing health concerns down the list of priorities as they looked for more attractive topics to lure financial support.118

A few local black medical associations organized talks on health and hygiene, but these were few and far between.119 In the South, most Southern medical practitioners and boards refused to support black health improvements and programs. This discriminatory behavior undermined the potential for health concerns to gain traction in the community.120

Despite the obstacles, some did try to organize larger portions of the African

American community around health. Monroe Nathan Work, a new professor at Georgia

116 For more on fraternal organizations and their relationship to public health, see David T. Beito, From Mutual Aid to the Welfare State: Fraternal Societies and Social Services, 1890- 1967 (Chapel Hill, NC: University of North Carolina Press, 2000).

117 Chapter 3 will discuss these projects in more detail. For more on the early contributions of women in the health field see Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890-1950 (Philadelphia, PA: University of Pennsylvania, 1995), especially 17-32; Mitchell, Righteous Propagation.

118 Allen, “The Negro Health Problem,” 201; Beito, From Mutual Aid to the Welfare State.

119 John A. Kenney, “Health Problems of the Negroes,” Annals of the American Academy of Political and Social Science 37 (January-June), 1911, 354-364.

120 McBride, From TB to AIDS, 25-27. 73

State College in Savannah, led one of the earliest efforts in 1905. Work had a long track record of community service. Born in 1866 as the son of former slaves, he originally trained to be a minister and worked at an A.M.E. Church in Wellington, Kansas in the early 1890s.121 However, his interest in data and studying the black condition led him to enroll at the University of Chicago in 1898.

After five years, Work left Chicago with both his bachelor’s and master’s degrees in sociology and having established himself in the field, becoming the first African

American published in The American Journal of Sociology.122 His article, “Crime Among the Negroes of Chicago, A Social Study,” noted that the highest proportion of crime occurred in the poorest areas of Chicago, black neighborhoods. While many social scientists at the time would have chalked this data up to inherent racial characteristics,

Work had another explanation. He argued that these were the same areas that Chicago’s white social settlements and relief organizations avoided. Not only did his paper help to explain why black neighborhoods had high crime, it also illustrated how white racism could affect African Americans.123 His research spurred him to dedicate his life to two goals: providing knowledge and opportunities for African Americans to improve their social condition and standing; and refuting inaccurate white conclusions about blacks.124

121 Jessica P. Guzman, “Monroe Nathan Work and His Contributions,” Journal of Negro History, 34(4) 1949: 428-461, 428-431.

122 Guzman, “Monroe Nathan Work and His Contributions,” 432-435; McMurry, Recorder of the Black Experience, 7.

123 Monroe N. Work, “Crime Among the Negroes of Chicago, A Social Study,” American Journal of Sociology 6(2) 1900: 204-223. Guzman, “Monroe Nathan Work and His Contributions,” 434-435. In her article, Guzman mistakenly writes that Work’s paper was published in 1901.

124 McMurry, Recorder of the Black Experience, 90. 74

Upon his arrival in Savannah, Work investigated the state of his race in his new city.

Here, Work found problems of health rather than crime. At the turn of the century,

Savannah’s white population averaged 245 more births than deaths, a number which stood in stark contrast to the African American number of 10 more births than deaths.125

While this figure demonstrated that Savannah blacks did not face extinction, it left little room for error. Work also found that while the city had sanitation problems with waste removal, a lack of understanding about prenatal and infant care, and the use of folk medicine all contributed to the low birth rate.126

The use of folk medicine was a common occurrence in both the North and South, but especially in the South where 90% of blacks lived at the turn of the century, often in rural areas that had little access to nurses and physicians. Here, black medical professionals were especially rare. The black doctor to black patient ratio in early twentieth century

America was 1:3,000, as opposed to 1:700 for white doctors and patients, and most black physicians practiced in cities.127 African American nurses too were few and far between, constituting less than 3% of all trained nurses in 1910.128 With medical professionals

125 McMurry, Recorder of the Black Experience, 37-38.

126 McMurry, Recorder of the Black Experience, 38. Malnutrition was a big problem for all children at the turn of the century. See Bullough and Rosen, Preventive Medicine in the United States, 1900-1990, 5-6; Winslow, The Evolution and Significance of the Modern Public Health Campaign, especially 53-58; Richard A. Meckel, Classrooms and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870-1930 (Piscataway, NJ: Rutgers University Press, 2013).

127 Reynolds Farley, Growth of the Black Population: A Study in Demographic Trends (Chicago, IL: Markham Publishing Co., 1970), 41; Byrd and Clayton, An American Health Dilemma, vol. 2, 398; U.S Bureau of the Census, Statistical Abstract of the United States, 1926 (Washington, D.C.: U.S. Department of Commerce, 1927), 13, 41; U.S Bureau of the Census, Statistical Abstract of the United States, 1910 (Washington, D.C.: U.S. Department of Commerce, 1910), 45.

75 unavailable and mistrusted, African Americans, like poor and ethnic whites, often turned to home remedies and folk medicine for care when ill.

As discussed earlier, many whites perceived the use of folk medicine as an indication of a lack of medical sophistication that confirmed a race or ethnicity’s inferiority. Yale

University doctoral graduate Newbell Puckett’s dissertation on African American folk treatments and theories encapsulated this viewpoint. As he explained, some practices involved attributing disease to evil spirits that healers and patients could drive off. For example, “a person who feels a chill coming on will run as fast as he can to keep the chill from catching him.”129 Another way to prevent sickness involved a different philosophy: giving the evil spirit somewhere else to go. To cure a cold, the patient might tie a frog to the big toe, causing the disease to move from patient to frog.130 In the age of germ theory and the growing appreciation of doctors, whites looking for evidence of their racial superiority used such thoughts and actions to paint the use of these methods as backward.

African Americans were not the only group using folk medicine. Poor Southern whites thought prayers or apologies could help the healing process.131 The large number of Italian immigrants who came to the U.S at the turn of the century used similar practices as African Americans. To heal kidney pain a person dragged his or her side

128 Hine, Black Women in White, 98, x-xi.

129 Newbell N. Puckett, Folk Beliefs of the Southern Negro (Chapel Hill, NC: The University of North Carolina Press, 1926), 359.

130 Puckett, Folk Beliefs of the Southern Negro, 365. Similarly, Frank A. Jones discusses a case of a young negro girl who wears a frog against her sore throat. See Frank A. Jones, “Some Medical Superstitions Among the Southern Negroes,” JAMA 50(15) 1908: 1207.

131 Phyllis D. Light, “A History of Southern and Appalachian Folk Medicine,” Journal of the American Herbalists Guild, 8(2) 2008: 27-38, 34. 76 along the walls of a church. Attaching and ringing a church bell with one’s teeth would cure a toothache.132 White native Americans intent on vilifying Italian Americans and other ethnic Eastern Europeans used these practices to belittle these groups, just like some did to African Americans. However, as these ethnic groups assimilated into

American culture, they were able to take advantage of social services, public health facilities, and medical professionals. The discrimination that they faced dissipated with succeeding generations.133 The same was not true for African Americans.

White conceptions of blacks as inferior and unintelligent received pseudo-scientific confirmation during the early 1900s as studies of skulls and brains became popular.

University of Michigan anthropologist Robert Bennett Bean’s 1906 study, “Some Racial

132 Nelide Romeo, Olivier Gallo and Giuseppe Tagarelli, “From Disease to Holiness: Religious-based health remedies of Italian folk medicine (XIX-XX century),” Journal of Ethnobiology and Ethnomedicine 11(50) 2015: 1-23, 19-20. Although this study focused on practices in Italy, the time period of the study was the period at which many Italians left for America, bringing these practices with them.

133 These immigrants often used race, in the form of black face and minstrelsy, as a way to distance themselves from blacks. See for example Michael Rogin, “Making America Home: Racial Masquerade and Ethnic Assimilation in the Transition to Talking Pictures,” The Journal of American History 79(3) 1992: 1050-1077. The white working class used this strategy as well. See Jerome P. Bjelopera, City of Clerks: Office and Sales Workers in Philadelphia, 1870-1920 (Urbana, IL: University of Illinois Press, 2005), 115-122. It should be noted that the road to immigrant acceptance by native born whites was not easy. These immigrants from eastern and southern Europe were considered to be of “an inferior stock.” The vast majority were unskilled and predominately Catholic or Jeiwsh , making assimilation difficult, especially considering many came to America not with the intent of settling, but to make money and then return home after a few years (Jews were an exception, they came to stay). Issues surrounding the immigration of these southern and eastern Europeans played a critical role as Congress debated the Immigration Act of 1924. For more on how the concept of “whiteness” and “good stock” have been used and applied for political, social, and economic gain, see Neil Irving Painter, The History of White People (New York, NY: W.W. Norton & Company, Inc., 2010), especially 327- 342. Marilynn Johnson gives a good overview of the animosity facing these new immigrants and the many strategies they used to try to combat the reactions of native born white Americans, including changes to religious practices. See Marilynn S. Johnson, The New Bostonians: How Immigrants Have Transformed the Metro Area Since the 1960s (Boston, MA: University of Massachusetts Press, 2015, especially 12-47. For more detail, see David R. Roediger, Working Towards Whiteness: How America’s Immigrants Became White: The Strange Journey from Ellis Island to the Suburbs (New York, NY: Basic Books, 2006). For more on the Jewish experience, see Karen Brodkin, How Jews Became White Folks and What That Says About Race in America (New Brunswick, NJ: Rutgers University Press, 1994). 77

Peculiarities of the Negro Brain,” was similar to others in that it illustrated how efforts to demonstrate white superiority knew no bounds and cared little for proper scientific practices. After dissecting 103 black brains and 49 white, he asserted that blacks had smaller brains. He deduced from this finding that African Americans had less-developed mental capabilities than their white counterparts.134 This conclusion seemingly proved white superiority and black inferiority once and for all. Indeed white authorities used the work of Bean, Murrell and many others to support continued segregation of the race and discrimination in economic, political, and social arenas. Such research also reinforced the brutal measures of lynchings and rapes as apparent necessities to teach a simple race its place in society and limit its ambitions.

However, a thorough study of Bean’s research reveals he found little actual difference in the sizes of the brains he investigated. He attributed this discrepancy to the types of brains he used, “It is well known that only the lowest classes of whites [body’s] are unclaimed…while among Negroes it is known that even the better class neglect their dead…”135 In addition to linking class with brain size, Bean’s racism led him to assume that African Americans did not care about funeral arrangements. This presumption led

Bean to conclude that he had access to black brains from all classes to compare to the small white brains he collected from unburied whites. When he found the brains of the

134 Robert Bennett Bean, “Some Racial Peculiarities of the Negro Brain,” The American Journal of Anatomy, 5 (September, 1906): 353-432. Earlier reports of brain discrepancies can be found in a wide variety of sources, see for instance: Calhoun, The Caucasian and the Negro in the United States.

135 Bean, “Some Racial Peculiarities of the Negro Brain,” 409. 78 two races were more or less equal in size, he drew the conclusion that the average white brain must be bigger.136

Such “science,” based entirely upon a belief in white superiority, greatly upset Work.

On his copy of Bean’s article he exclaimed “This study does not give any information about the anatomy of the brain. i.e. it does not appear to show that there are any anatomical differences between Negro and white brains!”137 Yet Bean’s and others’ conclusions, based on racial assumptions, threatened to justify the marginalization of

African Americans as both unintelligent and incapable of progress.

To improve black health while at the same time advancing African American standing, Work founded the Savannah Men’s Sunday Club in 1905. As President, Work focused the Club’s attention primarily on health education, asserting that poverty and ignorance, not genetic inferiority, caused the health concerns he saw.138 Work began his

Club’s efforts at church. Nationally, about one in three African Americans was a member of a religious organization.139 As a former minister, Work knew the importance of the

Church in the lives of African Americans and used its power to gain traction in raising health concerns in the city. The Club sent its members to black churches and worked with local ministers to arrange time during services to teach congregants about proper

136 Bean, “Some Racial Peculiarities of the Negro Brain,” 408-409. Mo Costandi, “On the Peculiarities of the Negro Brain” Neurophilosophy, March 14, 2007.

137 Bean, “Some Racial Peculiarities of the Negro Brain,”, 353, folder 2, box 8, Monroe Nathan Work (MNW), Tuskegee University Archives, Tuskegee, AL (TA).

138 McMurry, Recorder of the Black Experience, 111.

139 Sydney E. Ahlstrom, A Religious History of the American People (New Haven, CT: Yale University Press, 1972), 707-709. The author notes that 2.7 million African Americans belonged to a black church out of 8.3 million. 79 sanitation and warn against folk medicine. Having these discussions in the church implied the backing of church and community leaders. This apparent endorsement encouraged listeners to give greater credence to what the speakers said than they might have otherwise.

The Club also designated speakers to maximize its audience’s more welcoming attitude. Instead of sending just one speaker to each church, the Club sent multiple speakers, men and women, in “teams composed of physicians, dentists, and laymen.”140

Work wanted to make sure that everyone who heard a health talk would understand it.

Including both men and women meant that these talks were for both genders, that both needed to change their behaviors. He also recognized the mistrust some African

Americans, even the elite, had towards doctors. He worried that this wariness would make them unreceptive to health messages about sanitation and hygiene that they might have heard before from medical professionals.141 As Work explained, the laymen and laywomen were essential to ensure that the entire community got the message about health “in a language so simple that the most ignorant could comprehend what was being said.”142 Indeed, part of Work’s model involved empowering poor blacks. While Work was a member of the elite, he saw the inclusion of non-elites as vital to the Club’s work.

They removed the stigma of medical professionals from health information. Additionally,

140 Monroe Work, “A Health Week In Savannah Georgia In 1905,” October 11, 1930, 1, folder 9, box 4, National Negro Health Week (NNHW), TA.

141 For example, the black physician Charles H. Fowler urged similar practices in “Why the Death Rate Is High,” Baltimore Ledger, 2 April 1898, cited in Roberts, Jr., Infectious Fear, 80. Also hygiene was a big issue of the late 1800s in both white and black communities. See for example Tomes, Gospel of Germs, and Mitchell Righteous Propagation.

142 Monroe Work, “A Health Week In Savannah Georgia In 1905,” October 11, 1930, 2, folder 9, box 4, NNHW, TA. 80 their use of simple language to discuss health along with their ability to relate to the issues of the average African American encouraged all members of the black community to participate and educate each other.

Although the impact of the Club on Savannah is hard to decipher, the effect it had on

Work is more tangible. First, Work observed how the issue of health could galvanize the

African American community. Second, he saw that those who received health education eagerly put the knowledge to use.143 Savannah women formed Mothers’ Clubs to teach proper infant and child care and other committees worked to establish day nurseries.

Additionally, the Men’s Club joined with a women’s group to raise $10,000 for an annex to Savannah’s Charity Hospital.144 Third, he realized that, as his biographer Linda

McMurry puts it, “the club had at least helped make both races more aware of the problem in the city.”145 The power of health improvement to generate interest from both races became an important concept in Work’s future battles for African American health and a carrot for others to join his efforts. Fourth and last, the power of this racial uplift ideology, that blacks could improve their situation on their own, allowed Work to challenge accepted beliefs about African American health.146 Work asserted that African

Americans were not innately unhealthy, that they could control their health, and his campaign directly opposed the assertions of Hoffman and others.

143 Monroe Work, “A Health Week In Savannah Georgia In 1905,” October 11, 1930, 2, folder 9, box 4, NNHW, TA.

144 McMurry, Recorder of the Black Experience, 37-38.

145 McMurry, Recorder of the Black Experience, 38.

146 For more on racial uplift ideology, see Kevin K. Gaines, Uplifting the Race: Black Leadership, Politics, and Culture in the Twentieth Century (Chapel Hill, NC: University of North Carolina Press, 1996), Xiv; Mitchell, Righteous Propagation, 8-9. 81

Getting Bigger – Du Bois’ Call and Robert Moton’s Virginia Campaign

A year after Work’s Savannah campaign began, W. E. B. Du Bois released The

Health and Physique of the Negro American. Presented at the Eleventh Atlanta

University Conference held in 1906, this was the first detailed national examination of

African American health. As with The Philadelphia Negro, Du Bois’ Health and

Physique took on and dispatched the racist assumptions whites made about African

Americans. For example, it states: “The Conference does not find any adequate scientific warrant for the assumption that the Negro race is inferior to other races in physical build or vitality.”147 Like his other work, Du Bois noted that “The present differences in mortality seem to be sufficiently explained by conditions of life.”148 Environmental, economic, and social factors caused black poor health, not inherent racial characteristics.

In addition to demonstrating that African Americans were normal humans, the

Conference made a few resolutions to improve black health. Two of these involved better efforts to end the spread of tuberculosis and called on relief and social service groups to increase their support for African Americans. While these were worthy goals, they were largely outside of the control of most African Americans. They relied on the white philanthropists and white-led organizations attending the conference to take the initiative in supporting African American health improvement. Additionally, most of these groups had little influence in the rural South. The Conference made one other recommendation,

147 Du Bois, The Health and Physique of the Negro American, 110. Monroe Work wrote a piece on black and white brains which contributed to this conclusion, see The Health and Physique of the Negro American, 24-27.

148 Du Bois, The Health and Physique of the Negro American, 110. 82

“the formation of local health leagues among colored people for the dissemination of better knowledge of sanitation and preventive medicine.”149 Yet whether due to financial concerns, organizational issues, or political bickering within the African American community, African Americans organized few such leagues.

A few years after Work’s foray into creating a health movement, Robert Russa Moton organized a similar effort, but on a larger scale. A graduate of the Hampton Normal and

Agricultural Institute in 1890, Moton served as the school’s commandant of cadets in the early 1900s. However, he made health a priority as president of the Negro Organization

Society of Virginia. Founded in 1909, African American leaders in Virginia created the

Society to organize the disparate black organizations throughout the state. To that end, it allowed personal membership as well as the membership of various organizations, emphasizing cooperation over individual action. As W.T.B. Williams, Field Agent of

Hampton Institute and a member of the Organization put it, “Nearly every colored man and woman of Virginia is a member of some organization…If we could get hold of the organizations, indirectly at least, we would be getting hold of the individual.”150 This method, which allowed each small organization within the Society to maintain its autonomy, permitted the Negro Organization Society to grow quickly. Eventually, it comprised more than 250 black religious and secular organizations, representing about

350,000 black Virginians, about half of the state’s black population.151

149 Du Bois, The Health and Physique of the Negro American, 110.

150 Hampton Normal and Agricultural Institute, “Annual Report, Hampton Negro Conference,” Volumes 11-16, 68, July 19, 1911, Hampton Negro Conference.

151 Smith, Sick and Tired of Being Sick and Tired, 36. While Smith puts the founding of the Organization in 1910, the July 22, 1912 edition of the Boston Evening Transcript on page 7 83

When Moton became president of the Organization in 1912, the Society’s mission included four core initiatives: Better Schools, Better Health, Better Homes, and Better

Farms. Yet, like Work, when Moton surveyed his surroundings, the issue of health appeared paramount. A study in the early 1910s in Petersburg, Virginia discovered that on average, five more black babies died than were born in the city. This and similar data, combined with the health concerns Du Bois and others outlined led Moton to make health education the focus of his term.152 He organized a clean-up day throughout the state in

1912. Many white charities already used this tactic in cities and towns to improve urban areas with newly arrived immigrants.153 The program’s success encouraged Moton to expand it, adding more days and publicity to the 1913 clean-up initiative.154

To promote the clean-up campaign, Moton used tactics similar to the ones Work employed years earlier. He launched the campaign on a Sunday and asked the state’s black ministers to make health the focus of that day’s sermons. The Organization also

and the Annual Report, Hampton Negro Conference, Volumes 11-16 By Hampton Normal and Agricultural Institute (Va.), 8. 1912 Hampton Negro Conference, assert that the Organization was founded in 1909. The number of African Americans represented is also in dispute. August Meier, Negro Thought in America, 1880-1915: Racial Ideologies in the Age of Booker T. Washington (Ann Arbor, MI: University of Michigan Press, 1964), 123, argues that the Society, with its many smaller organizations, might have represented as much as 85% of the state’s African Americans.

152 Hampton Normal and Agricultural Institute, “Annual Report, Hampton Negro Conference,” volumes 11-16, 72, July 19, 1911, Hampton Negro Conference; Hampton Normal and Agricultural Institute, “Annual Report, Hampton Negro Conference,” volumes 11-16, 79, 1912 Hampton Negro Conference.

153 See for example, “Women’s Committee to Help a Mayor,” The Survey: Social, Charitable, Civic: a Journal of Constructive Philanthropy (The Survey) 31(25) March 21, 1914: 778; “Chicago’s Struggle for Scientific Garbage Collection and Disposal,” The Survey 31(25) March 21, 1914: 776-777; “New Efforts for a Flyless City,” The Survey 30(21) September 16, 1913: 635-638; “Irresponsibility in the Small Town: A Former Resident,” The Survey 29(20) February 15, 1913: 671-672.

154 Smith, Sick and Tired of Being Sick and Tired, 36. 84 published health statistics and gave prizes for the cleanest home, stable, and backyard.155

Like Work’s Savannah efforts, participation concentrated on things people could do to improve health without physicians present. While partially due to the stigma of medical professionals, this was mostly due to the limited access rural African Americans had to physicians and nurses. Most African Americans in Virginia and throughout the South lived far from the urban centers where physicians tended to congregate. Thus, making medical professionals the centerpiece of a health campaign would leave many people unable to fully participate.

As in Savannah, Moton encouraged whites to participate. Here though, his efforts went far beyond those of Work, and the scale and scope of the white establishment’s buy- in was particularly noteworthy. Local authorities and private white citizens awarded the prizes for cleanliness and donated wagons and carts to aid the clean-up activities.156

Governor William Mann publicly endorsed the campaign and the state’s white newspapers supported the initiative. The State Board of Health even agreed to publish the

Organization’s pamphlets.157

While thankful for the support of influential politicians, Moton thought the pamphlets were especially important to the health campaign. As he explained, the State Board of

Health often used “‘high-sounding or high-faluting’ medical words,” in its health

155 Robert R. Moton, Finding a Way Out: An Autobiography. 1920. Reprint, (New York, NY: Negro Universities Press, 1969), 173.

156 Moton, Finding a Way Out, 172-3.

157 “The Negro and Public Health,” AJPH 4 (July 1914): 624-625; “Clean-up Week in Virginia,” Southern Workman 43 (1914): 272; Robert Moton to Allen Petts, Managing Editor of the Times Dispatch of Richmond, VA, April 26, 1913, 340, “1913 January-May,” “Moton, Robert Roussa,” reel 61, Booker T. Washington Collection (BTW), TA. 85 pamphlets.158 Such language, Moton argued, was written for a highly educated audience and prevented many average African Americans from understanding how to fight disease.159 For example, many African Americans were unfamiliar with the word

“tuberculosis,” but knew “consumption.” Yet Virginia’s health officials only talked about how to defend against “tuberculosis.” As Work had argued, the issue was not a lack of interest in health; it was a lack of understanding and the inability of white health officials to explain health concerns in terms African Americans could comprehend.160 Making its own pamphlet using straightforward language would allow the Organization to create a more intelligent community “especially along [the] lines of sanitation and health.”161 This improved health education would lead to better health practices and a general improvement in the welfare of the State’s black population. Indeed, the Virginia Board of

Health thought the Organization’s advice on cleanliness so useful and accessible that it helped distribute health literature to 350,000 African Americans and published an additional 20,000 copies of the 1914 pamphlet to give to whites.162

According to Moton, the campaign was a resounding success, “It was said, when the campaign was over, that Virginia was never so clean in all of its history as on that

158 William H. Davis, National Negro Business League Annual Report of the Sixteenth Session and the Fifteenth Anniversary Convention (Washington, D.C., 1915), 160, TA.

159 The illiteracy rate in 1910 was 30% for African Americans, see “120 Years of Literacy,” National Center for Education Statistics, N/D, https://nces.ed.gov/naal/lit_history.asp.

160 Davis, National Negro Business League Annual Report of the Sixteenth Session and the Fifteenth Anniversary Convention, 160, TA.

161 Moton, Finding a Way Out, 173.

162 “An Economic Waste,” The Journal and Guide, February 13, 1915, in “Tuskegee Health Collection (THC), 1915,” 231, TA; Davis, National Negro Business League Annual Report of the Sixteenth Session and the Fifteenth Anniversary Convention, 160, TA. 86

Saturday night in April, 1913.”163 Although Moton originally targeted the clean-up initiative at rural families, he found that over 130,000 black heads of families participated, with a significant number living in urban areas.164 Spurred by this achievement, Moton decided to expand his clean-up days into a week and conducted a campaign specifically focused on getting blacks more access to tuberculosis treatment.

Only two places in all of Virginia treated blacks for TB in 1914, the state prison in

Richmond, and an insane asylum in Petersburg. Moton argued that because blacks worked in close proximity to whites and were about three times more consumptive, it was in the best interests of whites to build better health care facilities for blacks. More facilities would improve black health and protect whites as well. These arguments and the support Moton’s clean-up efforts received from the State Board of Health led Virginia to appropriate the money for a black sanatorium.165

Similar to Work’s efforts, Moton too recognized the impact the topic of health had not just on the well-being of blacks in particular, but also on interracial relations. As

Moton explained, “Leading white citizens united with the leaders of our own race, and met frequently to discuss the needs of the situation, such as law enforcement, housing, schools, health conditions, and other topics.”166 The Southern Workman agreed regarding the power of health, but attributed it more to the intersection of both black and white

163 Moton, Finding a Way Out, 173.

164 “The Negro and Public Health,” AJPH, 624-625; “Clean-up Week in Virginia,” Southern Workman 43 (1914): 272; Virginia Health Bulletin, 6(2) April 10, 1914, Virginia Department of Health, 67, 467, “Moton, Robert Roussa, 1914” reel 61, BTW, TA.

165 Moton, Finding a Way Out, 174-5; Virginia Health Bulletin 6(2) April 10, 1914, Virginia Department of Health, 67-68, 467-468, “Moton, Robert Roussa, 1914” reel 61, BTW, TA.

166 Moton, Finding a Way Out, 177-8. 87 interest “The principle of self-preservation demands that white men and black men must work together for the improvement of the living conditions of those who play a large part in the care of white children and white families.”167 Considering that the majority of

African Americans worked in service positions, white leaders and employers believed that blacks needed to be healthy so they could serve and take care of whites. Motivation notwithstanding, the ability of health to open a dialogue between blacks and “leading white citizens” about discriminatory issues demonstrated the importance of the topic.

Booker T. Washington and Health

Health had always interested Booker T. Washington, a former slave, who graduated from Hampton Institute and became the first principal of Tuskegee Institute in 1881. His autobiography, Up From Slavery, is full of references to cleanliness and general health practices, including, according to the historian Peter Coclanis, “twenty-two references to cleaning and cleanliness, eight to dirt, eight to sweeping, seven to washing, five to soiled persons or property, five to launder, four to filth.”168 One anecdote Washington included concerned how he taught black students in Malden, West Virginia to comb their hair, clean their faces, bathe, and use a toothbrush. As Washington noted, “In all my teaching I have watched carefully the influence of the tooth-brush, and I am convinced that there are few single agencies of civilization that are more far-reaching.”169

167 “Clean-up Week in Virginia,” Southern Workman 43 (1914): 272.

168 Peter A. Coclanis, “What Made Booker Wash(ington)?: The Wizard of Tuskegee in Economic Context,” in Booker T. Washington and Black Progress: Up From Slavery 100 years later, ed. W. Fitzhugh Brundage (Gainesville, FL: University Press of Florida, 2003): 81-106, 81.

Some see Washington’s story of bringing the best, that is to say, white health practices to blacks as a blatant attempt to establish himself as the civilizing leader of the black community. Indeed, Washington wrote Up From Slavery in large part to attract white philanthropy to support the development of Tuskegee Institute. This goal led him to omit certain elements from his life story, such as his interest in a law career, which did not conform to white perceptions about a black person’s place in society.170 The idea he wanted to instill in white minds was that blacks could improve themselves if they received proper leadership and support from the white community.

In Up From Slavery, Washington battles the dirt and grime that makes households uncivilized, just like members of the white middle-class. A white middle-class woman could easily relate to Washington’s experience sweeping floors at Hampton, “In a degree

I felt that my whole future life depended upon the thoroughness with which I cleaned that room, and I was determined to do it so well that no one could find any fault with the job.”171 Washington believed that programs that promoted black respectability were most likely to encourage interracial cooperation.172

169 Booker T. Washington, Up From Slavery (Boston, MA: Doubleday, Page & Company, 1901), reprint, William L. Andrews, ed., (New York, NY: Oxford University Press, 1995), 44.

170 See Louis Harlan, “Up from Slavery as History and Biography,” in Booker T. Washington and Black Progress: Up From Slavery 100 years later, ed. W. Fitzhugh Brundage (Gainesville, FL: University Press of Florida, 2003: 10-33, 21-24, 33. Harlan also notes that Washington included other elments in Up that did not happen to him. For Washington’s connections to white philanthropists, see Louis Harlan, Booker T. Washington: Volume 2: The Wizard of Tuskegee, 1901-1915 (New York, NY: Oxford University Press, 1983), 128-142.

171 Booker T. Washington, Up From Slavery, 165.

172 W. Fitzhugh Brundage, “Reconsidering Booker T. Washington and Up From Slavery,” in Booker T. Washington and Black Progress: Up From Slavery 100 years later, ed. W. Fitzhugh Brundage (Gainesville, FL: University Press of Florida, 2003), 9; Coclanis, “What Made Booker Wash(ington)?,” 92. 89

Washington’s leadership at Tuskegee reinforced his words in Up From Slavery on the significance of good health. He enforced clean health practices, held discussions on bathing, and improved the water quality, toilets, and sanitary conditions on campus.

Washington also organized health work outside of the school. He had students go into the town of Tuskegee to instruct locals on various health topics and he gave several speeches on cleanliness himself.173 Additionally, Washington organized a nurse training school and his Movable School taught rural blacks about the best health practices.174 These efforts allowed Washington to impress the white philanthropists who visited Tuskegee with the respectability of African Americans.

Although Washington’s initiatives and programs demonstrated his interest in health, they also illustrated the importance he gave this concept. All of his programs were local.

He used them, along with the Tuskegee Institute’s nursing program, as a way to give students appropriate education and practice in public speaking, interacting with others, and specific fields of employment. Washington’s goal was not to create a health movement, but just to train employable African Americans who would prove the race’s worth to whites.

However, health issues also concerned Margaret Murray Washington, Booker T.

Washington’s wife and co-founder of the National Association of Colored Women

173 “A Sunday evening Talk,” October 6, 1907, in Louis R. Harlan and Raymond W. Smock, ed., The Booker T. Washington Papers, volume 9, (Chicago, IL: University of Illinois Press, 1981): 366-71, 370; “Extracts from an Address before the Alabama Colored State Teachers Association,” March 25, 1910, in The Booker T. Washington Papers, volume 10: 292- 298, 296; “A Sunday Evening Talk” December 10, 1911, in The Booker T. Washington Papers, volume 11: 407-410.

174 Virginia Lantz Denton, Booker T. Washington and the Adult Education Movement (Gainesville, FL: University Press of Florida, 1993), 122-124. 90 established in 1896. In her role as Lady Principal of Tuskegee, Margaret Washington organized the Tuskegee Woman’s Club. It brought together local organizations and women’s clubs to work with local women to help them improve the squalid conditions many faced living on plantations. The Club taught women in these poor communities how to improve their homes through basic sanitation and hygiene practices they could implement with little cost. Its program promoted black economic self-determination, a goal of Booker T. Washington, by demonstrating, in the words of historian Jacqueline

Rouse, “how proper home management assisted their [black women’s] efforts to become financially independent.”175 The Club organized sewing groups and held classes on cooking, cleaning, and homemaking. It also held “mothers’ meetings” to help women care for their children.176 The success of the Tuskegee Woman’s Club’s work combined with Margaret Washington’s influence led the Alabama Federation of Colored Women

Clubs and the NACW to adopt much of its programming.177 Indeed Booker T.

Washington would later coopt much of this program as part of a larger public health campaign he oversaw.178

What changed Washington’s mind about the place of health in his worldview was not a specific incident. Instead, it was a conglomeration of events that included his feud with

175 Jacqueline Anne Rouse, “Out of the Shadow of Tuskegee: Margaret Murray Washington, Social Activism, and Race Vindication,” The Journal of Negro History 81(1/4) 1996: 31-46, 34.

176 Rouse, “Out of the Shadow of Tuskegee,” 33-35.

177 Rouse, “Out of the Shadow of Tuskegee,” 34. For more on the work of black settlement movement, of which the Tuskegee Woman’s Club was a part (and its program adopted by many), see Collier-Thomas, Jesus, Jobs, and Justice, especially note “Most black settlements,” 547.

178 This campaign was Negro Health Week, see Chapter 3. Similarities include the emphasis on cheap cleaning strategies and attention to child care. 91

W.E.B. Du Bois and Washington’s ambition to expand both Tuskegee’s program and his own influence. By the turn of the century, Washington and Du Bois had established themselves as the leading voices in the African American community. Although they both agreed that African Americans needed to improve their position in American society, they disagreed about the way to accomplish this goal.

Du Bois thought political action and a focus on civil rights were the keys to black economic and social progress. He favored a liberal arts education, not an industrial education where blacks trained (as at Tuskegee) to be servants and work with their hands and continue to serve whites. He thought that the small group of college-educated blacks,

“the Talented Tenth,” could guide the race towards this progress. And in the wake of the hundreds of blacks lynched and killed and their property destroyed during the Atlanta

Riot (1906) and Springfield massacre (1908), he joined with other national black leaders in organizing the Niagara Movement to establish resistance to racial segregation and disenfranchisement. The Movement opposed what its members believed were policies of accommodation and conciliation promoted by African-American leaders such as Booker

T. Washington. This led to the founding of the National Association for the Advancement of Colored People.179

According to Washington’s philosophy that he imparted to African Americans at the

1895 Cotton Exposition, blacks should focus on industrial labor and self-reliance, working hard in their jobs to show their utility to whites and gain their respect. For

179 W.E.B. Du Bois, The Autobiography of W.E.B. Du Bois: A Soliloquy on Viewing My Life from the last Decades of Its First Century (New York, NY: International Publishers, 1968), 121-156, 222-256; David Levering Lewis, W.E.B. Du Bois, 1868-1919: Biography of a Race (New York, NY: Holt, 1994), 55-92, 196-109; W.E.B. Du Bois, “The Talented Tenth,” in The Negro Problem: a series of articles by representative American Negroes of today, Booker T. Washington, et al., (New York, NY: James Pott and Company, 1903), 31-75. 92

Washington, economic security was more valuable to blacks than social advantages, higher education, or political office. Essentially, he advocated for black people to cease their struggle for equality and justice and accept their place in society. White philanthropists applauded his speech that accepted white authority and designated him the leader of African Americans. They gave generously to the institutions Washington created to embellish his image.180

Washington believed in racial solidarity, but saw himself as the leader of the race.

From Washington’s perspective, people were either for or against him and his philosophies. If someone opposed Washington, then Washington worked hard to marginalize that person. When Du Bois’ friend, the militant Boston editor William

Monroe Trotter, attacked Washington in his newspaper, the Boston Guardian, the

Tuskegee leader was furious. In response, with the support of white philanthropists, he bought out many black newspapers in order to control what they published. Unsatisfied with limiting Trotter’s influence in the media, Washington sent spies to Trotter’s meetings, a tactic he later used against Du Bois’ NAACP.181 Washington also organized his white friends and benefactors to boycott donations to Du Bois’ Atlanta University, eventually forcing Du Bois to leave his post at that institution.182 Yet even with all this

180 Booker T. Washington, Up From Slavery, especially 82-93 on Atlanta Exposition and 76-77 on connections to white philanthropists; Louis Harlan, Booker T. Washington: Volume 2: The Wizard of Tuskegee, 1901-1915 (New York, NY: Oxford University Press, 1983), especially 255 for the Atlanta Exposition and 128-142 for Washington’s connections to white philanthropists.

181 Harlan, Booker T. Washington: Volume 2, 32-62, 362-378; Du Bois, The Autobiography of W.E.B. Du Bois, 248; Stephen Fox, The Guardian of Boston: William Monroe Trotter (New York, NY: Atheneum, 1970), 29-80; Lewis, W.E.B. Du Bois, 234-264, 298-308. For the larger context of the Washington/DuBois conflict, see Harlan, Booker T. Washington: Volume 2, especially 23-106.

182 W.E.B. Du Bois, The Autobiography of W.E.B. Du Bois, 231, 252. 93 animosity between them, the two still agreed on many of the central issues facing the

African American community, including the importance of refuting the stereotype of the

“unhealthy Negro,” and the need to raise black awareness about health care.183

In the early 1900s, Monroe Work found himself in the middle of the Du Bois-

Washington disagreement. Even before Work had begun his foray into public health in

Savannah, he had started to gain acclaim for his research skills within the African

American community. Throughout 1905, Du Bois tried to recruit Work into Du Bois’ inner circle, inviting him to the first meeting of the Niagara Movement and including his critique of Robert Bennett Bean’s brain studies in The Health and Physique of the Negro

American.184 Du Bois targeted Work because both valued higher education, and not industrial education, as a way to improve the race. Work’s operating philosophy was that educated African Americans had a responsibility to help the race, a similar belief to Du

Bois’ emphasis on the “Talented Tenth.”185 Du Bois eventually got Work to join the

Movement, and asked him to serve in several capacities, including as the Movement’s state secretary for Georgia.186

Given Work’s Niagara leanings and the tension between Du Bois and Washington, it may surprise some that Washington recruited Work to come to Tuskegee. Yet necessity,

183 See for example Robert J. Norrell, “Understanding the Wizard: Another Look at the Age of Booker T. Washington,” in Booker T. Washington and Black Progress: Up From Slavery 100 years later, ed. W. Fitzhugh Brundage (Gainesville, FL: University Press of Florida, 2003): 58-80, 70-75.

184 W.E.B. Du Bois to Monroe Work, April 25, 1905, folder 6, box 2, MNW, TA. Work did not attend the meeting. Du Bois, The Health and Physique of the Negro American, 24-27.

185 McMurry, Recorder of the Black Experience, 101.

186 W.E.B. Du Bois to Monroe Work, October 23, 1905, folder 6, box 2, MNW, TA. 94 that mother of invention, made Work an important recruit for the Institute. During the first decade of the twentieth century, some in Washington’s inner circle noticed that

Washington had begun to either omit facts from his speeches, or use incorrect statistics.187 What Washington needed was someone with a specific interest in data collection to ensure the accuracy of his words, and Work’s reputation for statistical analysis was well known. For his part, Work had a greater loyalty to facts, figures, and

African American well-being than to Du Bois in particular, and the resources Tuskegee had at its disposal meant that he could expand his work. In 1908 he transferred to

Tuskegee to start its “Research and Records” department.188

Work’s role allowed him to explore a number of issues that affected the African

American community. He started tracking the number of lynchings throughout the country. He also gathered data on blacks generally, the types of jobs they worked, their education, crime statistics, overall population and dispersion, and other demographic items. In addition to supporting Washington’s speeches, this data provided further refutation of Hoffman’s thesis regarding the coming extinction of the African

American.189

Work’s position also gave him the ability to turn Washington’s head towards certain issues, and health in particular.190 The year Washington hired Work, Tuskegee conducted

187 Statement by Monroe Nathan Work to Lewis Al Jones, May 15, 1932, 1-2, folder 2, box 1, MNW, TA; Guzman, “Monroe Nathan Work and His Contributions,” 436.

188 Statement by Monroe Nathan Work to Lewis Al Jones, May 15, 1932, 2, folder 2, box 1, MNW, TA. The school later changed the name of the department to the “Department of Records and Research.”

189 Guzman, “Monroe Nathan Work and His Contributions,” 439.

95 its own “health week.”191 The celebration occurred in the midst of a typhoid epidemic at the school and helped renew Washington’s focus on the importance of health practices.192

The next year, the Tuskegee Annual Conference, which held discussions on how to improve opportunities for blacks in work, education, and in society at large, debuted a new session devoted exclusively to health. This session became a permanent addition to the Conference.193 The year after that, in 1910, Work began to look outside of Tuskegee to organize health initiatives. He convinced the American Tobacco Company and

Durham Hosiery Mill to cooperate with a black hospital to sponsor a nurse to visit black homes in the area. The purpose of these visits was to improve black home life. The nurse provided tips to improve health at each home she visited.194 While this program was small, it showed that Washington’s credibility, and the Tuskegee Institute name, provided reach well past the town of Tuskegee.

Beginning in 1911, Work began to push Washington to expand Tuskegee’s influence around the issue of health. He wrote to Washington, “I think you could make an effective plea to the people of Montgomery and of the towns throughout the state for better sanitary conditions among the Negroes. You could also outline a plan whereby the

190 McMurry, Recorder of the Black Experience, 70.

191 McMurry, Recorder of the Black Experience, 112.

192 Mary McLeod Bethune, “Recalls Vision of John A. Kenny as Negro Health Week Approaches,” Chicago Defender, April 1, 1950, 6; “Health Week Father Recalls How Plague Spurred its Birth in ’21,” Baltimore Afro-American, March 28, 1936, 7.

193 McMurry, Recorder of the Black Experience, 112-113; Robert Moton, “National Negro Health Week of Great Benefit to Negroes in South,” Supreme Circle, April 26, 1921, “THC, 1921,” 299-300, TA.

194 McMurry, Recorder of the Black Experience, 112-113. 96 colored and white could co-operate for sanitary improvement.”195 What Work wanted

Washington to do was to implement a plan similar to his Savannah Sunday Club initiative and debut it at the Annual Tuskegee Conference.196 To further emphasize the necessity of health, Work sent his research on child health to Washington, noting the 34% mortality rate of black children less than one year of age and the 11% rate of children under five.

These were significantly greater than the white children rates of 15% and 4%, respectively.197 Although Work did not include a plan for any specific health program in his letter, he did include health statistics for Northern cities to illustrate that black health was not a specifically Southern issue. Black health was a national problem that required a health campaign with vast resources behind it. While Work’s data could not sway

Washington that year, he did write to the Russell Sage Foundation to ask for funds to collect more information about black health. He also began contemplating a more significant health discussion at the 1913 Annual Conference.198

Along with his personal interests, Work pushed his health campaign idea because he perceived a growing interest in the topic throughout the country. The same year that

Moton’s Negro Organization Society held its first clean-up day, Tuskegee’s Tuberculosis

Committee organized one as well. Work also started collecting newspaper clippings

195 Monroe Work to Booker T. Washington, January 7, 1911, 94, “Jan-Feb 1911,” “Records and Research Work, Monroe Nathan,” reel 499, BTW, TA.

196 Monroe Work to Booker T. Washington, January 9, 1911, 95, “Jan-Feb 1911,” “Records and Research Work, Monroe Nathan,” reel 499, BTW, TA; Monroe Work to Booker T. Washington, January 24, 1911, 112, “March 1911,” “Records and Research Work, Monroe Nathan,” reel 499, BTW, TA.

197 Monroe Work to Booker T. Washington, May 16, 1911, 169, “March 1911,” “Records and Research Work, Monroe Nathan,” reel 499, BTW, TA.

198 Booker T. Washington to “To the Russell Sage Foundation,” July 11, 1911, in The Booker T. Washington Papers, volume 11: 264-265. 97 about health, all of which noted the sanitation issues blacks faced and called for whites to support and work with blacks to improve their health.199 Writing to Washington in

August of 1912, Work noted that “the National Medical Association is making serious efforts to improve the health and sanitary conditions among Negroes.”200 To Work, the

NMA’s focus on topics aside from specific medical practices indicated that the issue had reached a point of national concern, and he wanted Tuskegee to lead on this issue as it had on many others. His experience in Savannah had taught him that one need not have a medical degree to discuss health, and that simple explanations from familiar people could impact daily behavior. Since Work calculated that the number of black physicians, dentists, and pharmacists together did not amount to more than 4,000 people, those without medical expertise would be vital to improving black health.201

In addition to Work’s efforts to promote the topic, Robert Moton also played a significant role in putting health on Washington’s agenda. As Moton’s Negro

Organization Society’s efforts around health grew, he tried to capitalize on the growing publicity and influence by bringing the best-known African American in the country to witness and support the Society’s work. Following the success of the 1913 clean-up campaign in Virginia, Moton invited Washington to participate in a speaking tour on the

Society’s behalf. The purpose of the state tour was to maintain the Society’s momentum

199 Various newspaper clippings between February 23, 1912 and May 26, 1912, 432-433, “Health Week,” reel 690, BTW, TA.

200 Monroe Work to Booker T. Washington, August 27, 1912, 359, “June-September 1912,” “Records and Research Work, Monroe Nathan,” reel 506, BTW. TA; see also Kenney, “Health Problems of the Negroes,” 354-64.

201 Monroe Work to Booker T. Washington, August 27, 1912, 359, “June-September 1912,” “Records and Research Work, Monroe Nathan,” reel 506, BTW, TA. 98 and keep whites and blacks working together. The draw of Washington allowed Moton to keep the Negro Organization Society’s name within the purview of Virginia’s white newspapers, giving him a greater mouthpiece to discuss Society business.202 At the same time, Moton got the opportunity to show Washington what the Society’s clean-up efforts had accomplished throughout the state.

Moton doubled-down on his strategy later in the year when, after getting the

Governor’s acceptance, he asked Washington to speak at the Society’s annual meeting.

Again, such an offer guaranteed Moton added publicity for the Society and provided him the opportunity to impress Washington by giving him a first-hand view of the Society’s methods and goals.203 Moton noted that the biracial audience enjoyed Washington’s speech and the Society received significant coverage from white newspapers. As Moton explained with glee, “The Richmond colored people…have fallen in line most beautifully and nothing in Virginia has ever gotten hold of the Virginia white people, pulpit and press as this movement seems to have done.”204 Moton’s testimonials and Work’s research illustrated to Washington the growing role of health as a point of unity.

While Work and Moton both demonstrated the ability of African Americans to rally behind the issue, what especially appealed to Washington was the interest of whites. Both

Work and Moton had organized health weeks in which white leaders participated, a

202 Robert Moton to Allen Petts, Managing Editor of the Times Dispatch of Richmond, VA, April 26, 1913, 340, “1913 January-May,” “Moton, Robert Roussa,” reel 61, BTW, TA.

203 Robert Moton to Booker T. Washington, August 29, 1913, 384, “1913 June- December,” “Moton, Robert Roussa,” reel 61, BTW, TA; Robert Moton to Booker T. Washington, November 10, 1913, 430-431, “1913 June-December,” “Moton, Robert Roussa,” reel 61, BTW, TA.

204 Robert Moton to Booker T. Washington, November 10, 1913, 430, “1913 June- December,” “Moton, Robert Roussa,” reel 61, BTW, TA. 99 feature which appealed to Washington’s continued desire to gain more publicity, both for

African Americans as a whole and Tuskegee Institute in particular.205 Therefore,

Washington decided to use the 1914 Tuskegee Annual Conference as a referendum on the topic, to see if there was enough motivation, from both whites and blacks, to organize a greater initiative around the issue of health.

The Tuskegee Annual Conference and Health

The “Welfares Day” set aside for the health issue provided health information in a variety of ways. Work’s Department of Records and Research created a number of charts for the occasion. Work designed these visual aids not only to inform African Americans and the media about the many health concerns blacks had, but also to educate them about how those problems affected whites, and how to solve these issues. This last part was the distinct difference between the Department’s work and what many white medical experts had argued, namely that African Americans were incapable of solving their own health problems. When Work calculated that at any time in the South, 450,000 blacks were seriously ill, such calculus at first seemed to reinforce the argument that blacks, as a race, were inherently disease-ridden. As discussed earlier, the contemporary solution to black sickness often involved segregation or denial of care. Many white physicians and hospitals either rejected blacks or treated them as second-class citizens whose lives mattered little as compared to those of whites. Work introduced new information into this analysis. He calculated that sickness cost each African American in the South 18 days of work per year, which in turn cost the South about $75 million annually in lost

205 McMurry, Recorder of the Black Experience, 113. 100 production.206 This number ballooned to $300 million in total lost earnings when combined with time away caring for the sick, lost work due to deaths and funeral attendance, and obtaining and training new workers.207

Work’s data illustrated that black sickness did not simply affect whites by possibly infecting them. Rather, in a place where whites had made money off of black labor for decades, anything that affected the status quo and bottom line was worthy of examination. This same issue of using and exploiting black labor was what Washington used as the foundation of his argument to blacks that they prove their worth by producing for whites. So when Work noted that almost half of all African American illnesses and deaths were preventable, he found traction and interest about black health from both

Southern and Northern whites to a greater degree than many had thought possible.208

Work’s efforts went beyond simple financial calculations. He suggested specific solutions that would demonstrate African American adoption of accepted health practices, rather than direct challenges to the decision-makers. This message of racial uplift emphasized black adoption of white Victorian health ideals as a way to entice white elites to cooperate and aid blacks in their pursuit of improved health.209

206 McMurry, Recorder of the Black Experience, 114. Monroe N. Work, ed., Negro Year Book and Annual Encyclopedia of the Negro, 1914-1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 324-325.

207 Monroe N. Work, ed., Negro Year Book and Annual Encyclopedia of the Negro, 1914- 1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 331.

208 McMurry, Recorder of the Black Experience, 114; Monroe N. Work, ed., Negro Year Book and Annual Encyclopedia of the Negro, 1914-1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 325-326.

209 Gaines, Uplifting the Race, xiv; Susan M. Reverby, Ordered to Care: The Dilemma of American Nursing, 1850-1945 (Cambridge, MA: Cambridge University Press, 1987), 110. 101

At the Conference, Work made sure whites would perceive his suggestions for racial uplift as benign by using factual posters. One stated that pure food, air, and water would add 10 years to the average black life.210 In the early twentieth century, food had become especially important. The combination of the racism and discrimination that African

Americans faced, which limited their income and their geography, forced many into unhealthy eating practices. Southern blacks generally ate a fairly unvaried diet of meat, meal, and molasses, which meant they ate lots of fats and carbohydrates, but few vitamins. This diet made them susceptible to pellagra and other vitamin deficiency diseases.211 Additionally, the reliance on molasses and lack of available dentists made toothache a major health concern.212 Work’s diet suggestion, like Roman’s, was innocuous and represented an adoption of the “proper” eating habits of the time. Work’s suggestion also asserted that eating “correctly” was a way to improve one’s health outside of seeing a medical professional.

As a disciple of Du Bois, another Work poster compared the average life of an

African American, 35 years, to that of people in other countries, noting that those in India lived 10 years less, while those in Massachusetts, of all races, lived only 10 years more.213 The point of this comparison was to demonstrate that blacks were not that far

210 Monroe N. Work, ed., Negro Year Book and Annual Encyclopedia of the Negro, 1914- 1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 321.

211 Coclanis, “What Made Booker Wash(ington)?,” 91; Farley, Growth of the Black Population, 11.

212 Puckett, Folk Beliefs of the Southern Negro, 372.

213 Monroe N. Work, ed., Negro Year Book and Annual Encyclopedia of the Negro, 1914- 1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 320, 322. 102 behind the average life span of other groups. It also showed that blacks had made significant progress when compared to others considered to have poor health.

Work also emphasized the ability of cultures and races to progress. A poster showed the growth in life expectancy for all races in the past 300 years. The 17-year increase over the last half of the nineteenth century for all people showed improvement in universal health, which meant that black health also made gains.214 Work’s point was that blacks were not a lost cause and they would not just die out. Black health could, and indeed had, improved over the years and it was in the best interests of whites, both morally and financially, to support continued African American health. Work even calculated the savings. He noted that the South could recoup half of the $300 million it lost each year due to black illness simply by spending a little on improving black access to health care.215 Given the financial impact, Work challenged his audience to increase the average black life expectancy to 50 years by 1963.216

In addition to Work’s breakdown of the economic impact of black ill health on whites, the 1914 Annual Conference included a number of health demonstrations. The

Louisiana state Board of Health sent its two Health Cars to show proper sanitation methods and the National Child Welfare Committee of New York created an exhibit on

214 Monroe N. Work, ed., Negro Year Book and Annual Encyclopedia of the Negro, 1914- 1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 322.

215 Monroe N. Work, ed., Negro Year Book and Annual Encyclopedia of the Negro, 1914- 1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 331-332.

216 Guzman, “Monroe Nathan Work and His Contributions,” 452; Monroe Work, ed., Negro Year Book: An Annual Encyclopedia of the Negro 1914-1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 320. 103 child care.217 These displays attested to the reach of the Annual Conference, as well as the interest a variety of white organizations had in African American health. African

American leaders themselves also led a number of health discussions. The botanist and inventor George Washington Carver demonstrated the difference between pure and impure water, and a dairy instructor discussed proper ways for preparing dairy products, such as milk, butter, and cheese.218 In addition to providing important nutritional information to blacks, the purpose of these talks was to show the whites in attendance

African Americans trying to solve their own problems: they were not disease-ridden; they just lacked information about proper health care. If they had it, then they could become more productive.

Finally, Dr. John A. Kenney, a member of the NMA and the JNMA’s associate editor, along with his staff from the John A. Andrews Hospital at Tuskegee, conducted talks on traditional medicine.219 The purpose here was twofold. One goal was to further emphasize mainstream medical practices and calm black fears surrounding them. The second was to decrease African American use of folk medicine and home remedies.

Medical professionals and other elites of both races felt these practices made people look unsophisticated in matters of health. Advocating mainstream medical practices and discouraging traditional medicine would become themes in efforts to improve African

American health.

217 McMurry, Recorder of the Black Experience, 114; Denton, Booker T. Washington and the Adult Education Movement, 123.

218 Denton, Booker T. Washington and the Adult Education Movement, 123.

219 Denton, Booker T. Washington and the Adult Education Movement, 123. 104

The 1914 Conference illustratec certain elements of a coherent vision of how African

Americans perceived health. First, blacks could manipulate health. Poor health was not a genetic condition of African Americans from birth. Second, and related to the first, while

African Americans faced a wide range of diseases, blacks could decrease their chances of infection through simple, low-cost, methods, such as changing their diet or how they prepared food. This ability signaled that health education was a vital component for creating lasting change. Third, while doctors were useful, they were not necessary for

African American health improvement. Fourth, the topic of African American health had the potential to engender attention, financial and otherwise, from whites.

The interest the 1914 Conference generated, particularly in regards to the topic of health, drove Washington to explore the issue further, beginning with organizing black health groups and planning future conferences on the topic.220 However, by the fall of

1914, Washington began to dream of something bigger, something that would “dethrone disease and enthrone health and long life,” for all African Americans throughout the country.221 The solution he promoted went beyond Du Bois’ recommendation of local health leagues, Work’s Club efforts, and even Moton’s Virginia work.222

220 Booker T. Washington to Monroe Work, August 6, 1914, 374, “Aug-Dec 1914,” “Records and Research, Work, Monroe Nathan,” reel 533, BTW, TA; Monroe Work to Booker T. Washington, September 14, 1914, 391, “Aug-Dec 1914” “Records and Research, Work, Monroe Nathan,” reel 533, BTW, TA; McMurry, Recorder of the Black Experience, 114.

221 Booker T. Washington, Gallery Proof, January 15, 1915, 827, “National Negro Health Week,” reel 713, BTW, TA.

222 Du Bois, The Health and Physique of the Negro American, 110. 105

CHAPTER 3

IN THE BEGINNING: NEGRO HEALTH WEEK, 1915-1919

RESOLVED – That we commend the far-sighted vision and able efforts of the Executive Committee of the National Negro Business League for undertaking some years ago the improvement of health and living conditions among our people through the annual National Negro Health Week campaign. This has resulted in a greatly increased interest in the sanitation of homes and neighborhoods; it has aroused proper pride in maintaining the proper condition and appearance of streets and alleys and premises; and it also, with the growth of our people as property owners, is steadily raising the standards of housing, while prompting the more careful preservation as well as the beautification of homes and other buildings.

We recommend that this campaign be not limited to a week, as its title has indicated; but that instead the work be pushed with continued zeal, and with the even more complete co-operation of the whole League and all its friends, as the National “Negro Community Improvement Campaign.’ – in order to wage through a national and through local campaigns an effective crusade not only in personal education for Health, but more broadly for homes and surroundings that are safe against the ravages of disease, of fire, and the weather. Perhaps an “OPENING WEEK” is desirable, but there should be constant emphasis placed upon the real and continuous campaign.

– Special resolution adopted by the National Negro Business League at its Twentieth Annual Convention in St. Louis, MO, August 13-15, 1919.1

The National Negro Business League’s resolution reveals not only the extent of the marketing Washington’s disciples employed to assert the national reach of a as yet regional Negro Health Week campaign, but also the Week’s goals and potential. The health campaign did not focus on complex understandings of a particular disease or use

1 “Negro Health Week,” Nashville Globe, July 19, 1919, in “Tuskegee Health Collection (THC), 1920,” reel 552, Tuskegee Archives, Tuskegee, AL (TA). Note that this date precedes the actual NNBL meeting held August 13-15, 1919 so either the NNBL released an early resolution knowing it would be approved, or the handwritten date of the article is incorrect. 106 overly intricate language. Its focus on “the sanitation of homes and neighborhoods” made its health advice more universal and welcome as it spoke to participants in more familiar tones than that of the medical establishment. Indeed, the League thought the Week’s ability to arouse interest so powerful that it suggested a year-round campaign.

Yet the League asserted that such a campaign should have a different name, “the

National ‘Negro Community Improvement Campaign.’” During the late nineteenth century, people formed many visual improvement societies. By 1880 there were well over 200 rural and community improvement associations in the United States. The definition of “community improvement” was closely related to the defined needs of individual communities in different regions of the country, as well as location - rural, urban, village, town or city. Community improvement included health and living conditions, as well as “the betterment of community life” which could mean public playgrounds, gymnasiums, etc.2

The advice the Week provided primarily concentrated on sanitation and hygiene, not medicine, hence the name change suggestion. This focus was out of necessity since most

African Americans did not have access to the medical establishment through a combination of segregation, discrimination, geography, and poverty. Yet this emphasis, combined with the lack of medical leadership, made the campaign different from the other, white led, public health campaigns of the time and the name “Negro Health Week” stuck.

2 Mark Francis, “Control as a Dimension of Public-Space Quality,” in Public Places and Spaces, ed. Irwing Altman and Ervin H. Zube (New York, NY: Plenum Press, 1989): 147-172, 155. 107

Early White Public Health Campaigns

When Du Bois first proposed the concept of educating African Americans about health at the turn of the century, the idea seemed farfetched to most physicians. As noted in Chapter 2, some in the medical community thought that blacks lacked the capability to understand health. Furthermore, reaching so many people appeared impossible. The few white public health campaigns organized prior to the early 1900s were local and often centered on vaccinations or quarantines.3 Whites excluded African Americans from leadership in these campaigns and most ignored blacks altogether. As germ theory became more accepted, health officials, along with private physicians, began to organize around the idea of eradicating individual diseases. This transition inaugurated what some have termed the “golden era” of the American public health movement.4

Philadelphia doctor Lawrence F. Flick was one of the first to try to organize a large community against a particular illness. In 1892 he founded the Pennsylvania Society for the Prevention of Tuberculosis. One of the keys for Flick and those interested in forming groups to combat disease was to pick an illness that both lay people and doctors perceived as significant. Organizers needed an illness that had a public history and affected a wide variety of people. Such a disease would allow leaders to work on prevention, without having to convince the public of the evils, or even existence, of the illness. Tuberculosis (TB) lent itself to these criteria. It went by a number of different names, including consumption and the White Plague, giving it a notorious and even

3 For some examples of this type of treatment, see Michael Willrich’s Pox: An American History (New York, NY: The Penguin Press, 2011).

4 Nancy Tomes, Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998), 6-7. 108 folkloric status in the minds of the public. In 1890, the mortality rate in the registration states for tuberculosis of the lungs, the predominant form of tuberculosis, was 249 per

100,000, making it a scourge doctors saw on a regular basis.5

TB’s infamous reputation made many interested in Flick’s Society, but to be effective he needed to establish a clear vision for it. Several of the Society’s objectives differed markedly with past public health campaigns in terms of how Flick planned to attack TB, notably “by instructing the public in practical methods of avoidance and prevention…by visiting the consumptive poor and supplying them with the necessary materials with which to protect themselves against the disease and instructing them in their use…by furnishing the consumptive poor with hospital treatment.”6 In short, Flick proposed to teach those most susceptible to TB how to protect themselves. He perceived contracting

TB not as an example of a person’s immorality or as a sign of “Negro blood,” but as a problem that required treatment.7 However, this treatment would be administered in unequal, segregated sanitariums that had few beds for black consumptives.

Flick’s idea of having physicians and laypeople work together to improve health education about a single disease began to spread. By 1904, a few other TB associations had sprung up, but tuberculosis continued to be a major problem as the mortality rate in

5 Department of Commerce and Labor Bureau of the Census, Mortality Statistics 1907 (Washington, D.C.: Government Printing Office, 1909), 500. The registration area or states were the places from which the Census Bureau considered data to be reliable and consisted of Connecticut, Delaware, Washington, D.C., Maine, Massachusetts, Michigan, New Hampshire, New Jersey, New York, Rhode Island, and Vermont.

6 As cited in George Rosen, A History of Public Health, Expanded ed. (Baltimore, MD: The Johns Hopkins University Press, 1993), 364.

7 On attributing “Negro blood” for disease see Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore, MD: The Johns Hopkins University Press, 1997), 135. 109 the registration area only dropped to 177.3 per 100,000.8 While the TB associations could point to improvement in the mortality rate, the associations needed a better organization.

Therefore, in June of 1904, these associations gathered in Atlantic City to create the

National Association for the Study and Prevention of Tuberculosis, later renamed the

National Tuberculosis Association (NTA).9

After the establishment of the NTA, the number of voluntary TB associations skyrocketed. In the twelve years between Flick’s founding and the 1904 Atlantic City conference, only 17 associations had been established, most of which were in the urban

Northeast. During the next twelve years, the number soared to 1,324, spread across the

United States.10 While they operated in different ways, the core elements of each TB association involved educating the public and getting physicians and laypeople to work together.11

Public education about TB was a key component for the NTA. By explaining how people got infected and how to prevent infection, the Association raised awareness of TB and gave the average citizen tools to fight against it. Furthermore, having an educated citizenry became more important as citizens began to use the initiative and referendum processes to introduce and approve legislation. The clearer the NTA could make its

8 Michael E. Teller, The Tuberculosis Movement: A Public Health Campaign in the Progressive Era (New York, NY: Greenwood Press, 1988), 33-39; Department of Commerce and Labor Bureau of the Census, Mortality Statistics 1905 (Washington, D.C.: Government Printing Office, 1907), 36.

9 Rosen, A History of Public Health, 364-365. In 1918, the organizers changed the name to the National Tuberculosis Association.

10 Teller, The Tuberculosis Movement, 33.

11 Teller, The Tuberculosis Movement, 39-43. 110 utility, the greater interest it would generate, which would lead to more donations. The local associations then used these funds to build sanitariums for white TB patients and to advocate for legislation to help prevent TB, such as building codes that required homes to have more sunlight and ventilation.12

Although TB associations sent their literature to a wide range of people, like Flick’s original organization, they tended to target poor urban native-born and immigrant whites.

As the historian Nancy Tomes explains, in the late nineteenth century, “Sanitary knowledge and practice remained largely the province of middle- and upper-class families.”13 Generally speaking, these groups had the interest and time to learn about TB and could afford to take the necessary steps to decrease their susceptibility. Those that required education were the poor, the ones most expensive to educate due to their general lack of knowledge about germ theory or medical practice. The poor were also the ones who faced the greatest challenge in changing their vulnerability to TB given their scant financial resources.14

The task of education included a wide variety of tactics. Some of the first attempts involved newspaper advertising, printing pamphlets, and holding public lectures, strategies many local public health advocates used in the late 1800s. High density living in the urban northeast made the many passers-by more likely to be see and pick up advertising and pamphlets, making filling a lecture hall easier.

12 For example, see S. E. Earp, “Conference on Tuberculosis,” Indianapolis Medical Journal, 18(10) (October 15, 1915): 433-436; Teller, The Tuberculosis Movement, 43, 123; Tomes, Gospel of Germs, 126-129.

13 Tomes, Gospel of Germs, 54.

14 Tomes, Gospel of Germs, 54. 111

However, choosing the best education vehicle involved a consideration of investment.

Running a newspaper ad, while relatively inexpensive, had little guarantee of reaching the Association’s target audience in a meaningful way. The majority of African

Americans resided in the rural South, engaged in sharecropping and had little or no access to a newspaper. In urban areas, some of the working class and poor read newspapers, but not necessarily every day, and there was no guarantee the reader would turn to the page of the ad to get the needed information. More problematically, newspapers and magazines had a lot of ads in them, making the NTA’s message one of many, and thus easily forgotten. Newspaper advertising also limited the length of the TB

Association’s message since the bigger the ad, the greater the cost. Given that the associations needed to teach the public about both TB transmission and prevention, a newspaper ad limited the depth the associations could get into.

A pamphlet on TB offered associations the opportunity to provide more detail about both transmission and prevention. However, pamphlets were more expensive to produce than a newspaper ad and came without a built-in distribution system. TB association members had to go door-to-door to distribute the pamphlets or stand on sidewalks to hand them out, a strategy that was not applicable to and would not reach the majority of blacks.

Such methods had little guarantee of reaching those that most needed the information, as likely ending up in the trash as being read cover-to-cover. Additionally, such pamphlets often most interested those who had TB. Since there was no cure for TB, prevention, not treatment, was the best way to lower mortality. TB patients taking pamphlets meant that the associations’ messages did not reach their target market. 112

The NTA’s public lectures faced similar problems to the pamphlets. The purpose of holding lectures was to reach the wide swath of people who did not come across the

NTA’s advertisements or pamphlets. These talks had the benefit of having an expert speak to the public about the problem of TB and how to check the disease. Lecturers could excite and enthrall an audience, use charts, and take the time to carefully explain and interpret data in ways a newspaper ad or pamphlet could not. However, those most likely to attend these lecturers were the Association members themselves, who came from the middle- and upper-classes and had free time. Public lectures could also be expensive. NTA members had to create fliers publicizing the event, obtain lecture space, and find a speaker, all with no guarantee that the message would reach the target audience. Additionally, as with the pamphlets, those already exposed to TB were often the ones who attended these talks, making the prevention emphasis a “too little, too late” proposition.15

To improve publicity and outreach, the NTA took a page out of the marketing playbook, essentially organizing a campaign around the concept of selling health.16 The

NTA needed to generate interest in the topic for those who did not have the disease. One way to do this was to emphasize the size and scope of the problem, an idea Monroe Work later used at the 1914 Tuskegee Annual Conference in discussing the effect sick blacks had on the economy. Like Work, the NTA put the problem of tuberculosis in dollars. It estimated that between 1903 and 1911, the annual economic cost of TB to the U.S. was between $330,000,000 and $622,513,904.70 in terms of health care costs, funeral

15 Tomes, Gospel of Germs, 114-117.

16 Tomes, Gospel of Germs, 18-19, 117-134. 113 expenses, and work lost.17 Given these figures, both rich and poor could recognize that

TB was a significant problem for Americans.

Another way to capture the public’s attention was to seize on new media to distribute content. The arrival of the motion picture generated excitement across the nation. People wanted to see movies, which led to a general demand for more films, regardless of content. The relatively low cost of a movie ticket, especially when compared to other forms of popular entertainment, meant that both the rich and poor could access this new media. Therefore, the NTA started making dramatized movies about TB and how to prevent it, movies which met with a ready audience regardless of their knowledge of, or experience with, TB.18 The NTA also created a traveling exhibit on TB which toured the

U.S. from 1906-1912. Like the films, the traveling exhibit gave the public an opportunity to understand TB and how to prevent it in ways that simple words on a page could not.

While the TB exhibit required a similar amount of advance effort to that of a public lecture, the payoff was much greater. The exhibit offered tangible, interactive elements to educate the public along with the ability to see it at one’s leisure, as opposed to a one- time lecture.19

17 Teller, The Tuberculosis Movement, 34.

18 Tomes, Gospel of Germs, 120-121; Martin Pernick, “The Ethics of Preventive Medicine: Thomas Edison’s Tuberculosis Films; Mass Media and health Propaganda,” Hastings Center Report 8 (June 1978): 21-27. For more on public health films, see Martin Pernick, The Black Stork: Eugenics and the Death of “Defective” Babies in American Medicine and Motion Pictures since 1915 (New York, NY: Oxford University Press, 1996).

19 Tomes, Gospel of Germs, 120-122; S. Adolphus Knopf, A History of the National Tuberculosis Association: The Anti-Tuberculosis Movement in the United States (New York, NY: National Tuberculosis Association, 1922), 33; Philip P. Jacobs, The Tuberculosis Worker (Baltimore, MD: Williams and Wilkins, 1923), 18-19; Virginia Lantz, Denton, Booker T. Washington and the Adult Education Movement (Gainesville, FL: University Press of Florida, 1993), 123. 114

In addition to using new media and traveling exhibits, the NTA also targeted children in its campaigns. In 1908, the NTA worked with the Red Cross to sell stamps promoting the movement. This collaboration helped both to educate the public and raise money.20

The campaign’s success led the NTA to use children to sell stamps without the Red Cross as a partner. These children, who received “ranks” based on how many stamps they sold, also had to learn about TB and prevention techniques in order to explain the stamps.

According to Tomes, such outreach reflected “the growing recognition among health educators that children responded to hygienic direction more quickly and positively than did their parents.”21 Children, not yet set in their ways, could alter their behavior more easily than adults, and the images of young kids working for the campaign helped make photogenic recruiting posters.

In terms of the education the NTA provided in its literature, Tomes explains that the group, like others advocating for the public’s health, such as insurance companies and the

YMCA/YWCA, followed “a basic of rule of thumb [which] was that the more humble the home, the simpler the message it needed about the ways of the germ.”22 While the rich had the time to understand the science of tuberculosis, the NTA thought the working class and poor needed a more basic message.

This is not to say that the NTA ignored science. Indeed, it advocated science and tried to explain the reasoning behind its recommendations. However, it simplified its message using the language of religion, a similar strategy to that of Monroe Work in Savannah,

20 Tomes, Gospel of Germs, 122-123; Teller, The Tuberculosis Movement, 41-42.

21 Tomes, Gospel of Germs, 123.

22 Tomes, Gospel of Germs, 186. 115 although on a much grander scale. The NTA worked with churches to organize a

“Tuberculosis Sunday,” which included a sermon on TB and a collection for the organization.23 Instead of phrasing methods of TB prevention as “advice,” pamphlets described them as “commandments” or “catechisms,” and utilized the rhetoric of a

“Crusade against TB” to motivate the public to “win the war.”24 The NTA hoped that the religious rhetoric and the church’s influence would convince congregants of a link between TB prevention and their religion, causing them to incorporate NTA recommendations into their daily lives. Although the NTA wanted the public to understand the reasons for its suggestions to fight TB, it favored implementation over understanding. Recommendations had to be easy to follow, which led the NTA to focus its message on actions people could take at home. The NTA illustrated how even the poorest person could take steps to prevent tuberculosis and live a healthier life, such as simply opening windows or making sure one got sunlight each day.25

Writing in 1923, Charles-Edward Amory Winslow, chairman of the department of

Public Health at Yale University between 1915 and 1945, declared “The discovery of popular education as an instrument in preventive medicine, made by the pioneers in the tuberculosis movement, has proved almost as far-reaching in its results as the discovery of the germ theory of disease thirty years before.”26 As he saw it, all diseases could be

23 Tomes, Gospel of Germs, 122, 128.

24 Tomes, Gospel of Germs, 122-125.

25 Tomes, Gospel of Germs, 117-124.

26 Charles-Edward Amory Winslow, The Evolution and Significance of the Modern Public Health Campaign (New Haven, CT: Yale University Press, 1923, reprint (South Burlington, VT: Yale University Press, 1984), 53. 116 fought effectively through educating the public about the ways illnesses spread and prevention methods. Specifically, Winslow suggested that organizations focus on “…the mothers who bring up the babies and the men who pay rent in the tenements and work in the stores and factories.”27 Those most at risk for health problems, poor white and ethnic immigrants, needed the most outreach, particularly in caring for and educating the next generation.

Thus, many public health campaigns in the early 1900s shared similarities with the

NTA. The American Public Health Association, the American Social Hygiene

Association, and the Children’s Bureau all used public education tactics to spread their ideas. The groups used conferences, public lectures, and pamphlets similar to the NTA’s.

The Children’s Bureau and the Health Association also taught lessons on infant feeding and general nutritional information for raising children, even providing milk stations to those without access to healthy dairy options.28 In this way, they imitated the NTA’s initiative to make health issues more accessible to the public and provided hands-on interaction similar to that of the NTA’s health exhibits.

The Rockefeller Sanitary Commission for the Eradication of Hookworm Diseases incorporated religious rhetoric along with the more traditional outreach strategies of public lectures, pamphlets, and newspaper ads. However, the greatest element of overlap concerned the idea of educating the populace. Like the NTA, the Sanitary Commission brought together medical experts, public health officials, church leaders, educators, and

27 Winslow, The Evolution and Significance of the Modern Public Health Campaign, 55.

28 George Rosen, Preventive Medicine in the United States, 1900-1975, Trends and Interpretations (New York, NY: Prodist, 1976), 7-47. For more on the Children’s Bureau specifically, see Robyn Muncy, Creating a Female Dominion in American Reform, 1890-1935 (New York, NY: Oxford University Press, 1994), 93-119. 117 the press to spread information on hookworm and its prevention.29 While the

Commission did not eradicate hookworm, and its campaign had a much shorter life than that of the NTA, just five years, it had perhaps a more lasting effect. Prior to the Sanitary

Commission, the few public health bureaus in the South had received little financial support and many of the doctors who ran them worked part-time. The Commission helped to establish a network of state and local public health agencies complete with full- time doctors. Additionally, the publicity the Commission generated led Southern states to increase their public health spending by 81% between 1910 and 1914.30 This network of agencies would be of great help to the Negro Health Week organizers.

Public health campaigners argued that efforts to educate the public about health had a significant impact. By 1920, the TB rate in the registration area had decreased to 114.2 per 100,000, and the 1930s hookworm rate had diminished by two-thirds compared to that during the Sanitary Commission period.31 To many, it seemed that these campaigns had taught ethnic immigrants about disease prevention, which helped them assimilate into, as historian George Rosen puts it, “…an American way of life.”32 That is to say, ethnic immigrants utilized their health education to help them demonstrate their similarity to Americans.33

29 John Ettling, The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South (Cambridge, MA: Harvard University Press, 1981), viii, 147-148, 213-217.

30 Ettling, The Germ of Laziness, viii, 147-148, 211-222; C. Vann Woodward, Origins of the New South, 1877-1913 (Baton Rouge, LA: Louisiana State University Press, 1951), 425-428.

31 Department of Commerce, Bureau of the Census, Mortality Statistics 1920 (Washington, D.C.: Government Printing Office, 1922), 36.

32 Rosen, Preventive Medicine in the United States, 1900-1975, 47.

118

Black Public Health Work Before NHW

Unfortunately, many of the health campaigns of the time ignored African Americans, or reinforced racist perceptions of them as dangerous or stupid. The NTA’s focus on prevention led it to criticize those who became infected, the most obvious of whom were

African Americans. While the percentage of black urban TB deaths decreased from 15% in 1900 to 12.8% in 1920, the white decrease from 9.85% to 6.7% suggested that African

Americans remained more susceptible to TB and that blacks could not learn to prevent

TB as effectively as whites.34 Similarly, in Baltimore’s lung wards, where African

Americans had high rates of TB, the historian Samuel Kelton Roberts Jr. explains that surveys described “black disease and black neighborhoods as objects of study different from white ones.”35 Frederick Waller’s study on alley dwelling in Washington, D.C. portrayed the “average alley” as consisting of massive numbers of black consumptives due in part to “their ignorance as to diseases.”36 Given the advances whites had made

33 Many historians have noted examples of ethnic immigrants intentionally adopting American practices to gain acceptance. See for example Suellen Hoy, Chasing Dirt: The American Pursuit of Cleanliness (New York, NY: Oxford University Press, 1995); Russel A. Kazal, Becoming Old Stock: The Paradox of German-American Identity (Princeton, NJ: Princeton University Press, 2004).

34 Samuel Kelton Roberts, Jr., Infectious Fear: Politics, Disease, and the Health Effects of Segregation (Chapel Hill, NC: University of North Carolina Press, 2009), 4.

35 Roberts, Jr., Infectious Fear, 111. For more on the Lung block, see 107-138. For primary source reading on the study, see “Urban League to Study ‘Lung Block’” Baltimore Afro- American, March 7, 1925, 10.

36 Frederick Weller, Neglected Neighbors: Stories of Life in the Alleys, Tenements, and Shanties of the national Capital (Philadelphia, PA: Winston, 1909), 20-26, especially 23. 119 against TB, the high rates for blacks indicated to some that TB was a sign of black racial degeneration.37

Even so, the emphasis on public education and tracking progress in disease prevention opened some opportunities for African Americans. The white racism that led some to contend that blacks understood their own race the best led whites to carve out some space for African Americans in public health.38 The Henry Phipps Institute in

Philadelphia, directed by Flick and Henry R. M. Landis, both white, was one of the first efforts. Opened in 1903, the Institute hired black physicians and nurses to treat black TB patients.39 Similarly, although the NTA separated its white and black affiliates, it did organize a few black TB societies in urban areas due to the prevalence of the disease in the African American community. Yet these efforts proved to be outliers as discrimination and segregation remained constants in most white-led organizations.

While the Sanitary Commission worked with the NMA to get the Tuskegee Institute’s Dr.

John A. Kenney to chair a committee to study hookworm infection in blacks, the

Commission never employed a black doctor.40

One of the first significant efforts in the South to organize black resistance to TB was

Tuskegee Institute’s First Negro Congress on Tuberculosis, held in December of 1908.

37 Roberts, Jr., Infectious Fear, 5; Teller, The Tuberculosis Movement, 97. Nancy Tomes presents a similar idea regarding Russian Jews in Gospel of Germs, 129-130.

38 Roberts, Jr., Infectious Fear, 16.

39 Roberts, Jr., Infectious Fear, 63-64; David McBride, Integrating the City of Medicine: Blacks, in Philadelphia health Care, 1910-1965 (Philadelphia, PA: Temple University press, 1989), 39-48; Barbara Bates, Bargaining for Life: A Social History of Tuberculosis, 1876-1938 (Philadelphia, PA: University of Pennsylvania Press, 1992), 291-326.

40 Ettling, The Germ of Laziness, 174. 120

Although African Americans planned the Congress, they asked the NTA to send speakers and the meeting included a significant NTA influence. The Congress, lasting one week, labeled it a “Health Week” and called the Sunday the week began, “Health Sunday.”41 In addition to including an exhibition on TB that explained the basics of how it spread and prevention techniques, the Congress encouraged disseminating this information across a wide range of outlets. It recommended that in addition to charities and medical societies, schools needed to get involved and teach students about the disease and about the body generally. The Congress even suggested that secret societies “take up tuberculosis topics in ten minute talks ‘for the good of the order.’”42 It also advocated the NTA’s approach of using short, specific messages instead of long lectures to instruct health education.

The Congress included two other noteworthy suggestions. First, the primary recommendation the Congress made was for churches to take the lead. According to the

Congress, church leaders should give sermons on TB while women’s groups within the church conducted follow-up efforts on the sermons and distribute materials on TB.

Regardless of the issue, the church was the focal point upon which to build a campaign.

Second, the Congress encouraged blacks and whites to work together and provided strategies to support interracial work. It emphasized that whites wanted to help blacks because it was in their own best interests. In fighting TB, it was not morality but self- interest that would decrease the health discrimination that blacks faced.43

41 Program for “First Negro Congress on Tuberculosis,” December 13-19, 1908, Vertical files, C4 “Health-Health Week,” TA.

42 Program for “First Negro Congress on Tuberculosis,” December 13-19, 1908, Vertical files, C4 “Health-Health Week,” TA.

121

Although the Congress brought together a variety of African American medical and non-medical leaders, in the eyes of white public health authorities it had little success in jump-starting a black TB movement. Following the Conference, C. P. Wertenbaker, an official of the U.S. Public Health and Marine Hospital Service, tried to organize a broad system of black TB societies. Like Monroe Work, Wertenbaker thought black churches provided the best avenue to create a TB organization and he started his organizing here.

His messaging for these societies mimicked the NTA’s. He emphasized both seeing a physician as well as basic avoidance strategies, such as not spitting.44

Such a focus demonstrated Wertenbaker’s misunderstanding of African American issues. First, few white physicians would see blacks. Second, while the small cohort of black physicians was mostly concentrated in cities, the vast majority of African

Americans lived in the rural South with little ability to travel to far away urban areas. The need for black TB societies to work with physicians meant that they were often located in urban areas. This location prevented most African Americans from practicing the avoidance strategies since they could not get access to the TB pamphlets and information.

Additionally, most societies failed soon after they began due to problems with fundraising and organization. While these issues stemmed from employment discrimination that left blacks with the lowest paying jobs, Wertenbaker blamed these

43 Program for “First Negro Congress on Tuberculosis,” December 13-19, 1908, Vertical files, C4 “Health-Health Week,” TA.

44 C. P. Wertenbaker, “Colored Antituberculosis League: A Proposed Plan of Organization,” Washington, D.C.: Government Printing Office, 1909, 4, box 771 35147, Pamphlet Collection, New York Academy of Medicine, New York, NY (NYAM); C. P. Wertenbaker, “A Working Plan for Colored Antituberculosis Leagues,” Washington, D.C.: Government Printing Office, 1909, 6-10, box 771 36434, Pamphlet Collection, NYAM. 122 issues on the race as a whole.45 It is noteworthy that what blacks needed most was money for field workers to travel the rural South teaching health education, but white public health officials did not consider this idea. Thus, as the historian Michael Teller concludes, blacks were “one group whom the tuberculosis movement rarely reached.”46

Yet there were some successful attempts at organization. These primarily occurred in urban areas with concentrations of African American professionals. In Atlanta, the city’s club women formed the core of the Negro Anti-Tuberculosis Association. These women and other supporters mostly came from the elite and had adopted strict standards of personal morality similar to those of elite whites. Historian Michele Mitchell notes that in

African American literature, “Overriding concerns with moral cleanliness and literal sanitation dominated….discourse on home life,” a focus that the historian Nancy Tomes also found in writing aimed at whites.47 The organization sent surveys to blacks, many of whom were domestic servants who lived in alleys and dilapidated houses without running water and toilets owned by white landlords. These surveys examined sanitation and ventilation, along with other hygienic issues. The Negro Anti-Tuberculosis Association then worked with the white anti-TB Association to get the city health board to force landlords to fix the problems.

45 “The National Negro Antituberculosis League,” Journal of the American Medical Association (JAMA) 2(12) 1909: 969-970; Teller, The Tuberculosis Movement, 51.

46 Teller, The Tuberculosis Movement, 51.

47 Compare Michele Mitchell, Righteous Propagation: African Americans and the Politics of Racial Destiny After Reconstruction (Chapel Hill, NC: The University of North Carolina Press, 2004), 142 to Tomes, Gospel of Germs, especially 134-172. The women came from many clubs, such as a variety of church clubs, but also the local affiliate of the National Association of Colored Women. 123

Like the Congress, Atlanta’s Negro Anti-Tuberculosis Association recognized the necessity of whites and blacks working together on the issue and perceived this interracial work as a path toward achieving greater racial equality. In working with whites, organization members pointed out the limitations blacks faced in terms of available housing and income. They argued that segregation and discrimination in housing prevented blacks from living in homes where they would be less likely to get a disease, and living in such conditions also decreased their ability to fight disease. While these discussions did not lead to anything even close to ending discrimination or segregation in the city, black homes got fixed and sanitation improved. By the mid-

1920s, Atlanta’s blacks had one of the lowest TB death rates in the country.48

Atlanta was not the only example of white and black collaboration. In Richmond,

Virginia, the black Anti-Tuberculosis League worked with white public health nurses to provide treatment. Here, white motivation to participate had to do with the economics associated with tourism. The city’s white leaders felt that disease rates would affect the perception of the city, limiting the number of visitors and leaving the impression that

Richmond’s citizens lived in squalor.49

Regardless of the motivating factors, work between the races helped spur changes in how public health workers conceived of their role. Forced to interact with black citizens, white health workers found that African Americans could learn “proper” health practices and had an interest in improving their health. The historian Edward Beardsley explains

48 Tomes, Gospel of Germs, 221-230.

49 Steve Hoffman “Progressive Public Health Administration in the Jim Crow South: A Case Study of Richmond, Virginia, 1907-1920,” Journal of Social History 35(1) (Autumn, 2001): 185-187. 124 that by the American Public Health Association’s 1914 meeting, “The bulk of Southern health officers…believed that by implementing proper sanitary, housing, and social policies, the Negro’s health decline could be halted.”50 Based on their experiences working with African Americans, public health workers were increasingly unwilling to accept Hoffman’s assertion that the African American race would die out. Doctor A. G.

Fort exemplified this growing perspective. With his eleven years of working in various parts of rural Georgia as a guide, he concluded that the biggest factor in poor black health was not some inherent propensity for disease. Instead, by working with black patients,

Fort learned that many had little understanding of proper sanitation techniques and little money with which to implement them. He found that when officials taught African

Americans good health practices blacks could implement, their health improved.51

Such conclusions supported two different tactics in dealing with black health: a bottom-up approach that involved supporting black institutions so that black professionals could teach the race about health; and a top-down approach that involved white professionals dictating black health practices. In terms of the bottom-up approach, between 1912 and 1919, the number of black hospitals and nurse training schools increased from 63 to 118.52 Yale University’s Winslow perceived this increase in nurses as vital to health education and improvement since they often conducted home visits to

50 Edward H. Beardsley, A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South (Knosville, TN: University of Tennessee Press, 1987), 130;

51 A. G. Fort, “The Negro Health Problem in Rural Communities,” American Journal of Public Health (AJPH) 5(3) 1915:191-193.

52 Vanessa Northington Gamble, “Roots of the Black Hospital Reform Movement,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, eds. Judith W. Leavitt and Ronald L. Numbers, 3rd ed. (Madison, WI: University of Wisconsin Press, 1997), 374. 125 teach “proper” health practices so others could put them to practice.53 However, while most of these new training schools and hospitals were in the South, they were small institutions located in urban areas. Thus, they could not reach the vast majority of African

Americans in the rural South.

On the other hand, many whites still felt that directing and overseeing black activities was the best method to improve black health. As discussed earlier, the white TB

Association in Atlanta did not help blacks on its own. Instead, it waited for the Negro

Anti-Tuberculosis Association to come to it with concerns. The white TB Association then chose the particular housing issue or sanitation problem it would advance. In addition, white Atlantans made a number of proposals to protect white employers and their families that gave them oversight of black bodies. They suggested requiring black domestic employees obtain a particular license or submit to a medical exam by the city.54

Similarly, during World War I, several Army camps required black soldiers returning from leave to submit to chemical prophylaxis. The historian John Parascandola explains that the Army’s racist assumptions about blacks being unable to control their sexual desires combined with the idea that “African Americans were especially ignorant about sex hygiene…[and]…that they would be difficult to educate.”55 These perceptions about blacks may have led the Army to diagnose venereal disease more often in black soldiers.

53 Winslow, The Evolution and Significance of the Modern Public Health Campaign, 56; Gamble, “Roots of the Black Hospital Reform Movement,” in Sickness and Health in America, 375.

54 Tera W. Hunter, To ‘Joy My Freedom: Southern Black Women’s Lives and Labors After the Civil War (Cambridge, MA: Harvard University Press, 1997), 205-213.

55 John Parascandola, Sex, Sin, and Science: A History of Syphilis in America (Westport, CT: Praeger, 2008), 67. 126

The historian Alan Brandt argues that the disproportionate number of venereal disease cases the Army found during World War I, 58% of black soldiers, as opposed to 10% of white soldiers, indicated that “it is probable that many Army physicians were predisposed to diagnose many ailments among black troops as sexually transmitted.”56 Such mistreatment, both in diagnosis and in policies, led many black soldiers to refuse treatment or even health education.57 Whites sometimes interpreted this refusal as disinterest in health, and combined with high illiteracy rates in the black population, 44% in 1900, 30% in 1910, and 23% in 1920, concluded that blacks could not learn proper self-help and care.58

Additionally, whites still blamed blacks for the spread of disease. The historian Tera

Hunter explains that in Atlanta, “Whites were likely to be seen as victims [of sickness], however, blacks as perpetrators.”59 Even when health officials decided blacks were immune to a disease, this did not mean that blacks were immune to attack. When Charles

Wardell Stiles, one of the premier researchers of hookworm disease, found that blacks had what he called a “relative immunity” to the disease, he interpreted this protection as relating only to hookworm symptoms, not to the disease itself. He concluded that blacks

“are therefore not so likely to come under treatment, but…are likely to act as spreaders of the disease to the rest of the community…thereby killing thousands and causing serious

56 Alan Brandt, No magic Bullet: A Social History of Venereal Disease in the United States Since 1880, expanded edition (New York, NY: Oxford University press, 1987), 116.

57 Parascandola, Sex, Sin, and Science, 69.

58 “120 Years of Literacy,” National Center for Education Statistics, N/D, https://nces.ed.gov/naal/lit_history.asp.

59 Hunter, To ‘Joy My Freedom, 195. 127 disease among tens of thousands of others.”60 Thus, even as the Sanitary Commission handed out hookworm information to both races, the Commission’s racism moved it towards a philosophy of forcing blacks to get treatment, rather than working with them.61

Before the Call

By the fall of 1914, the influence of Washington’s colleagues, his own interests, and the popularity of public health campaigns all led him to promote what he called a “Health movement” for a race that the medical establishment overlooked. More directly, the success of Moton’s clean-up efforts with the Negro Organization Society of Virginia led

Washington to mimic the Society’s work.62 Though Moton gave Washington his approval to organize a larger movement, Washington did not want to offend Moton by taking over the work the Society had begun. As Washington explained to Moton, “I do not want to interfere with your own plans, but rather to emphasize what you have been doing so well in Virginia.”63 As originally envisioned in November of 1914, Washington wanted to schedule either a health day or week to occur in unison with the Society’s activities.64

60 Charles Wardell Stiles, “Hookworm Disease in Its Relation to the Negro,” Public Health Reports (1896-1970) 24 (31), Association of Schools of Public Health, 1086. doi:10.2307/4563435.

61 Ettling, The Germ of Laziness, 172-176.

62 Moton’s work with the Negro Organization Society of Virginia is discussed in Chapter 2.

63 Booker T. Washington to Robert Moton, November 25, 1914, in Louis R. Harlan and Raymond W. Smock, ed., The Booker T. Washington Papers, volume 13, (Chicago, IL: University of Illinois Press, 1984), 187.

64 Robert Moton to Booker T. Washington, November 28, 1914, 512, “Moton, Robert Russa 1914” reel 61, Booker T. Washington Collection (BTW), TA; Booker T. Washington to Robert Moton, November 30, 1914, 513, “Moton, Robert Russa 1914” reel 61, BTW, TA; Monroe 128

The movement would also mimic the work being done in Virginia by reaching out to state Boards of Health, black schools, and leading African Americans, with a specific focus on interesting ministers and businessmen.65

Both Moton and Work celebrated Washington’s decision, but they approached the organization of the movement in different ways. Moton sounded a cautious tone, “it takes some time to educate the people along the lines of cleaning up.”66 He wanted to lower

Washington’s aspirations and noted that it had taken the Society years to build up its campaign. Work was much more positive about what the movement could accomplish.

While Moton believed the movement’s success depended on convincing community leaders that health and sanitation were important, Work argued that African Americans already knew about these issues. For example, the Chicago Defender included a health section. Ministers of the Colored Baptists in Washington, D.C. discussed the need to lower the death rate and national organizations, such as the National Association of

Colored Women and the NMA, had already created health and sanitation arms. In addition to the Negro Conference, the Society’s work, and that of the Atlanta Anti-

Tuberculosis Association, Work found that cities in North Carolina, Alabama, and

Louisiana already conducted clean-up campaigns.

Work to Booker T. Washington, November 27, 1914, 431, “Aug-Dec 1914,” “Records and Research, Work, Monroe Nathan,” reel 533, BTW, TA.

65 Robert Moton to Booker T. Washington, December 15, 1914, 518, “Moton, Robert Russa 1914” reel 61, BTW, TA; Monroe Work to Booker T. Washington, November 27, 1914, 431, “Aug-Dec 1914,” “Records and Research, Work, Monroe Nathan,” reel 533, BTW, TA.

66 Robert Moton to Booker T. Washington, December 15, 1914, 518, “Moton, Robert Russa 1914” reel 61, BTW, TA. 129

To Work, the diversity of these efforts meant that African Americans understood the importance of health. As he explained to Washington, the missing element was the formal organization of these initiatives. Bringing them all together at one time would help

African Americans everywhere better understand the efforts they made to improve themselves, and their health, and to feel united in the process of uplifting the race.67

The Call

The issue of organization remained one of the biggest concerns Washington’s campaign faced in its early days. While Washington and Tuskegee were famous names, unlike the NTA, there were no local affiliates throughout the country to promote the campaign. Therefore, Washington asked the National Negro Business League (NNBL), which had a number of branches throughout the U.S., all of which included important local businessmen, to support the movement. Washington’s status as a leader and NNBL founder, along with Work’s health statistics on the economic benefits of healthy blacks, convinced the NNBL’s Executive Committee to support the Week.68 This was not a hard sell. In addition to Washington’s influence, the NNBL supported the work of the Negro

Organization Society of Virginia and was already familiar with its efforts.69

67 Monroe Work to Booker T. Washington, November 27, 1914, 431, “Aug-Dec 1914,” “Records and Research, Work, Monroe Nathan,” reel 533, BTW, TA; Jessica P. Guzman, “Monroe Nathan Work and His Contributions,” Journal of Negro History, 34(4) 1949: 428-461, 452.

68 Booker T. Washington to James Carroll Napier, January 7, 1915, in The Booker T. Washington Papers, volume 13: 218.

69 Vanessa Gamble and Deborah Stone “U.S. Policy on Health Inequities: The Interplay of Politics and research,” Journal of Health Politics Policy and Law 31 (1), February 2006: 93-126, 101. 130

With the infrastructure of the Business League behind him, Booker T. Washington’s initial call to observe Negro Health Week (NHW) in 1915 went out in January.70 To publicize the campaign, he used his influence with the editors of African American newspapers in the North and South to publish his call-to-arms. Whereas this newspaper focused strategy had caused the NTA problems, it was more useful for Washington since he targeted a much smaller group of people than the NTA. Additionally, Washington’s celebrity status within the African American community meant that newspapers regularly covered him. People without newspaper access demanded news of Washington from those who read the papers, which helped news about NHW get to rural blacks. There was no need to purchase ad space like the NTA. Many newspapers agreed to run the Tuskegee press releases, and many more ran their own articles on the Week knowing it was good business to support Washington.71

70 In Roscoe C. Brown’s history of National Negro Health Week, he states that the Week was originally titled, “National Health Improvement Week,” see Roscoe C. Brown, “The National Negro Health Week Movement,” Journal of Negro Education 6, 1937: 553-564, 553. However, both The Chicago Defender (“Dr, Washington Gives Reasons for Health Week,” February 6, 1915, 1) and Baltimore Afro-American (“How to Keep Good Health,” March 27, 1915, 7) published articles in the first months of the Week which included the phrase “National Negro Health Week.” Additionally, the organizers of National Negro Health Week used the phrase themselves at the movements outset, see for example Emmett Scott and Monroe Work to Booker T. Washington, undated, 237, “1915” “Records and Research, Work, Monroe Nathan,” reel 548, BTW, TA. The official pamphlet of the Week, “The Conservation of Negro Health,” uses the phrase “National Negro Health Week” as well as “Negro Health Week” to describe the health campaign. See “The Conservation of Negro Health,” 1-6, 829-832, “National Negro Health Week,” reel 713, BTW, TA. As discussed in the Introduction, I will use the term “Negro Health Week” to describe the public health campaign during the years 1915-1920 since it was essentially a regional campaign in the South until the U.S. Public Health Service got involved in 1921.

71 Booker T. Washington had significant influence at many of these papers, such as the New York Age, The Indianpolis Freeman, and the Chicago Leader. In particular he had a close relationship with T. Thomas Fortune, the editor and co-owner of the Age and counted the many editors of The Freeman as supporters as well. Both these papers at times ran articles that Washington either asked or paid them to run. Washington later purchased the New York Age, subsidized the Leader, and worked to get his supporters installed at black newspapers throughout the North. For more on this see Emma L. Thornbrough, “More Light on Booker T. Washington and the New York Age,” The Journal of Negro History 43(1) (January 1958): 34-49; 131

Taking a cue from Moton and Work, Washington cast his net for support for the

Week far and wide. He asked medical organizations, such as the NMA, National

Association of Colored Graduate Nurses (NACGN), State Medical Associations, and

State Health Officers for assistance.72 However, he did not limit himself to health oriented groups. He also called upon the National Association of Teachers in Colored

Schools, the National League on Urban Conditions Among Negroes, the National

Association of Colored Women (NACW), and the National Negro Press Association.

Additionally, he appealed to black insurance companies, farmers societies, church leaders, and even secret societies to aid in the movement.

Washington’s emphasis on reaching out to groups women led signaled his recognition of the extensive community organizing power and national network they possessed, especially the NACW. Among its other activities, the NACW adopted elements of

Margaret Washington’s Tuskegee Woman’s Club. It organized mothers’ clubs to teach black women best practices for caring for children and home management, including sweeping, dusting, cooking and washing.73 Outside of the NACW, black women led

August Meier, “Booker T. Washington and the Negro Press: With Special Reference to the Colored American Magazine,” The Journal of Negro History 38(1) (January 1953): 67-90; Harlan, Booker T. Washington: Volume 2, 96-106.

72 By the “National Association of Graduate Nurses” Washington meant the “National Association of Colored Graduate Nurses.”

73 Deborah Gray White, Too Heavy a Load: Black Women in Defense of Themselves, 1894-1994 (New York, NY: W. W. Norton, 1999), 27-29, 91. It is worth noting that Washington’s wife, Margaret Murray Washington, was closely connected to the NACW, having helped to organize it and serving as its first Executive Committee Chairman and fifth President (1912- 1916). See “All United,” Washington Bee, 15(8), July 25, 1896, 4. She also originated much of the programming adopted by the Tuskegee Woman’s Club, Alabama Federation of Colored Women Clubs, and the NACW. See Jacqueline Anne Rouse, “Out of the Shadow of Tuskegee: Margaret Murray Washington, Social Activism, and Race Vindication,” The Journal of Negro History 81(1/4) 132 numerous local programs in secular and non-secular organizations, making them a particular asset in jump-starting a new campaign.

The emphasis on non-health group involvement was an important element of the movement and marked a major difference in what the term “health” meant to African

Americans compared with the medical establishment. Washington and the leaders of

NHW perceived health as something that everyone could work to achieve. This idea differed from that of TB associations and those in the developing medical field, both of which emphasized the role of check-ups and doctors to ascertain health. While the NTA and other public health campaigns encouraged laypeople to work with physicians, they wanted physicians to lead.74

By contrast, Washington encouraged laypeople to lead, an inclusive approach grounded in the realities of the situation. First, the general dearth of African American medical practitioners, such as nurses, doctors, and dentists meant that relying on this small group of people to organize local campaigns would limit the Week’s ability to expand, and likely prevent it from reaching the small towns and rural areas that had few

African American health professionals. For that reason, it made sense to incorporate a variety of non-medical groups into the movement. Second, neither Washington, nor

Moton, nor Work had a medical background, which made setting a medical agenda difficult.

1996: 31-46, 33-34. Her status and relationship to Washington may have encouraged him to specifically ask this group to participate.

74 For example, physicians led the American Public Health Association. See Regina Markell Morantz-Sanchez, Sympathy and Science: Women Physicians in American Medicine. New York, NY: Oxford University Press, 1985), 282. 133

Third, and perhaps most importantly, Washington focused Negro Health Week on the ability of individuals to take measures to improve their own health because of his understanding that health affected all facets of African American life. As Washington put it in his call, “Without health and until we reduce the high death-rate it will be impossible for us to have permanent success in business, in property getting, in acquiring education, to show other evidences of progress. Without health and long life all else fails.”75

Sickness and disease limited black income, which restricted both the ability to pay for advanced schooling and the types and quality of housing African Americans could possess. The primary cause of the wealth disparity between blacks and whites was racial discrimination, which limited black wealth since it affected education, employment, promotions, and pay scales, all of which privileged whites. White leaders spent less on black schools and educating black students than on whites, and many white schools took steps to limit or ban black students from attending. This situation left most African

Americans with the skills to take on only the lowest paying jobs. These conditions remain true today.76 However, Washington’s emphasis on accommodation and self-help made him focus his attention on what blacks could do to help themselves.

75 Booker T. Washington, Gallery Proof, January 15, 1915, 827, “National Negro Health Week,” reel 713, BTW, TA. Among other newspapers, this Gallery Proof was published verbatim in The Chicago Defender and the Baltimore Afro-American on January 23, 1915. It ran in the Philadelphia Tribune on February 13, 1915.

76 See for example Kriston McIntosh, Emily Moss, Ryan Nunn, Jay Shambaugh, “Examining the Black-white wealth gap,” brookings.edu 27 February 2020 < https://www.brookings.edu/blog/up-front/2020/02/27/examining-the-black-white-wealth-gap/> (25 May, 2020); Christian Weller, “Getting Serious About Closing Racial Wealth Gap Means Looking for New, Large Solutions,” forbes.com 14 January 2020 < https://www.forbes.com/sites/christianweller/2020/01/14/getting-serious-about-closing-racial- wealth-gap-means-looking-for-new-large-solutions/#4104dbcf4fbf> (25 May 2020). 134

From his perspective, African Americans needed the tools to make health improvements on their own, and better health would help uplift the race in other aspects.

As the historian Peter Coclanis summed up Washington’s perspective, “It is not at all a stretch to suggest that Washington…believed that by changing their cleanliness behaviors, rural African Americans would not only improve their physical environment and enhance their physical health, but also gradually acquire, internalize, and routinize the virtues that would at once stabilize their social situations and set them on the path to the slow accumulation of modest amounts of wealth.”77

Fourth, since black ill health also affected how whites perceived blacks, Washington argued that the entire race needed to participate in understanding and improving its health. Furthermore, whites had to be able to see black health improvement with their own eyes. Whites could not observe blacks going to black doctors. Whites usually visited doctors of their own race. However, whites could see blacks cleaning up their own neighborhoods. While the Week’s health practices would improve black health, Coclanis notes that “‘All that scrubbin’ may have had other, psychosocial effects as well, particularly by demonstrating to some white, middle-class Americans that many African

Americans aspired to the same norms and championed the same values and virtues as did they.”78 This is not to say that African Americans imitated whites to gain acceptance.

Instead, the Week provided blacks the opportunity to reveal the similarities of the health

77 Peter A. Coclanis, “What Made Booker Wash(ington)?: The Wizard of Tuskegee in Economic Context,” in Booker T. Washington and Black Progress: Up From Slavery 100 years later, ed. W. Fitzhugh Brundage (Gainesville, FL: University Press of Florida, 2003): 81-106, 92.

78 Coclanis, “What Made Booker Wash(ington)?,” 96. Italics in original. While Coclanis was discussing the washing and cleaning that took place in Up From Slavery specifically, his analysis is true of the health campaign that Washington lead. 135 practices and needs of the two races. In this way the Week subtly challenged segregation and other discriminatory practices.

According to Washington, the topic of health was so important for African Americans that it could even create truces with long-time adversaries, such as W.E.B. Du Bois.

Washington ended his call by saying “We may differ on other subjects, but there is no room for difference here. Let us make a strong, long united pull together.”79 Although, recent scholarship has suggested that the two actually agreed on a number of issues, such as racial solidarity and self-help, the topic of health seemed particularly suited to reducing antagonism.80 Both Du Bois and Washington hit on the same method to improve black health and alter the perception of the “unhealthy Negro”: health education for

America’s blacks. Examining Philadelphia, Du Bois found eight causes for blacks’ high rates of death and illness in the city, including “1. Lack of proper training… 5. Neglect of their children… 6. Unwholesome and improper feeding [of children]… 7. Ignorance.”81

According to Du Bois, simple health education could fix half of the sources of sickness in

Philadelphia and, by implication, for all blacks in the country. This research

79 Booker T. Washington, Gallery Proof, January 15, 1915, 827, “National Negro Health Week,” reel 713, BTW, TA.

80 For more on agreements between Du Bois and Washington, see Robert J. Norrell, “Understanding the Wizard: Another Look at the Age of Booker T. Washington,” in Booker T. Washington and Black Progress: Up From Slavery 100 years later, ed. W. Fitzhugh Brundage (Gainesville, FL: University Press of Florida, 2003): 58-80, especially 70-75; W. Fitzhugh Brundage, “Reconsidering Booker T. Washington and Up From Slavery,” in Booker T. Washington and Black Progress: Up From Slavery 100 years later, ed. W. Fitzhugh Brundage (Gainesville, FL: University Press of Florida, 2003), 3-9; August Meier, Negro Thought in America, 1880-1915: Racial Ideologies in the Age of Booker T. Washington (Ann Arbor, MI: University of Michigan Press, 1964), 196.

81 W.E.B. Du Bois, ed., The Health and Physique of the Negro American, Report of a Social Study made under the direction of Atlanta University, on May the 29th, 1906 (Atlanta, GA: The Atlanta University Press, 1906), 90. 136 corresponded with Monroe Work’s statistics eight years later at the 1914 Tuskegee

Annual Conference when he declared that 45% of all black deaths were preventable.82

Likewise, Du Bois’ suggestion of “local health leagues” was similar to the way NHW worked at the local level, creating local NHW committees to oversee the campaign.83

However, a closer look at Washington’s call illustrates historian August Meier’s claim that “…a large part of Washington’s motivation [for his actions] was his desire for power.”84 An astute observer in the Baltimore Afro-American noted, “Booker T.

Washington mentioned a number of organizations as being desired as participants in a national health week, but he seemingly forgot to include the National Association for the

Advancement of Colored people[sic] in the important movement.”85 It seems unlikely that Washington “forgot” to include Du Bois’ NAACP. It is far more likely that, although

Washington believed the issue of health could bring people together, it could not overcome his personal problems with DuBois.

Yet, as Meier and more recent scholars have argued, his decision did not make

Washington insincere or megalomaniacal.86 Washington believed in the Week, but he wanted to lead it. The goal of the Week was not to create healthier African Americans

82 Linda O. McMurry, Recorder of the Black Experience: A Biography of Monroe Nathan Work (Baton Rouge, LA: Louisiana State University Press, 1984), 114. Monroe N. Work, Negro Year Book and Annual Encyclopedia of the Negro, 1913 (Tuskegee, AL: The Negro Year Book Publishing Company, 1914), 325.

83 Du Bois, The Health and Physique of the Negro American, 110.

84 August Meier, Negro Thought in America, 1880-1915, 116.

85 Untitled article, Baltimore Afro-American, January 30, 1915, 4.

86 Meier, Negro Thought in America, 1880-1915, especially 116; also see Norrell, “Understanding the Wizard,” especially 70-75; Brundage, “Reconsidering Booker T. Washington and Up From Slavery,” 3-9. 137 who would boldly advocate for their rights, as Du Bois might have wanted. As the historian Christopher Crenner explains, “Du Bois saw the unequal burden of sickness [on blacks] as evidence first and foremost of injustice.”87 In contrast, Washington envisioned

Health Week as creating healthier blacks who would be more productive. More production would improve their economic self-determination. This increase in production would also generate greater profits for the many whites who supervised, utilized, and relied on black labor. From this perspective, Washington envisioned that white employers, having seen the benefits of healthy black employees, would help support black health. In this vision, better black health did not challenge the white supremacist views of most whites.

Washington’s ideas about health used as the foundation for the Week were not revolutionary. As the historian Michele Mitchell has observed, African Americans had long seen their fate interconnected with that of other members of the race.88 In the late

1800s, health and advice columns in black periodicals, manuals, and pamphlets focused on assisting “individuals desirous of achieving and performing fitness for collective membership and national citizenship.”89 While the advice concentrated more on how to conduct oneself in public rather than health, Mitchell explains that the literature argued

“that routine conduct could either bolster or undermine collective weal.”90 That the

NACW often led these efforts made Washington’s emphasis on the inclusion of women

87 Christopher Crenner, “Race and Laboratory Norms: The Critical Insights of Julian Herman Lewis (1891-1989),” Isis 105(3) 2014: 477-507, 505.

88 Mitchell, Righteous Propagation, 8-9.

89 Mitchell, Righteous Propagation, 112.

90 Mitchell, Righteous Propagation, 115, 117. 138 more a shrewd use of an already available resource, rather than a magnanimous gesture to women.91

In terms of health campaign creation and advice, in addition to using strategies adopted from the NTA and other public health campaigns, efforts to improve hygiene and sanitation were ubiquitous at the turn of the century. Settlement houses and charity workers tried to inculcate regular bathing and cleanliness into newly arrived Southern and

Eastern European immigrants in the late 1800s and early 1900s. These people were unfamiliar with “proper bathing” and other health practices the white middle-class championed. Such poor habits, combined with their ethnicity, led many nativists to attack the character of these new immigrants.92

The local health campaigns in immigrant communities thus held the prospect of raising an immigrant’s stock in white society by demonstrating assimilation. Where

Washington innovated was on the scale of his approach and his emphasis on the formalization of health practices as a way to support lay empowerment to improve black communities.93

After the Call

91 Mitchell, Righteous Propagation, 149-150; Hunter, To ‘Joy My Freedom, 213-217.

92 Tomes, Gospel of Germs, especially 186-231; Suellen Hoy, Chasing Dirt: The American Pursuit of Cleanliness (New York, NY: Oxford University Press, 1995), 92-104. For some examples of these attacks including and beyond health, see Karen Brodkin, How Jews Became White Folks and What That Says About Race in America (New Brunswick, NJ: Rutgers University Press, 1998); David R. Roediger, Working Towards Whiteness: How America’s Immigrants Became White: The Strange Jounrey from Ellis Island to the Suburbs (New York, NY: Basic Books, 2006).

93 Although Washington had already seen this latter element in the work of his wife, Margaret Murray Washington, and her Tuskegee Woman’s Club on a local scale, See Chapter 2. 139

Once the call went out on January 23, 1915, the question remained as to how exactly to organize the campaign. Washington could not send a personal representative to every county and city that had African Americans. He also could not rely solely on the organizations that he had asked for help because most of their members lived in cities and larger towns. Focusing on these groups would ignore the vast majority of blacks who lived in the rural South. Given Washington’s and Tuskegee’s limited financial resources,

Washington decided to use black newspapers, not only as a communication tool, but also as a way to encourage people to create their own local programs, a very different strategy from the more structured NTA or Rockefeller Commission. While a grassroots campaign would be difficult to control, it would empower African Americans and hopefully encourage more to participate.

To motivate local grassroots organizing, Monroe Work and Washington’s secretary,

Emmett Scott, used a number of strategies. The first was to flood black newspapers with health information. In addition to having these newspapers publish regular notices about

NHW until it commenced on March 21, Work compiled an assortment of health data that the newspapers published as well. The idea was that emphasizing the variety of health issues African Americans faced would create more interest in participating.94 These articles stressed the susceptibility of the young, noting that 27% of all black deaths involved diseases of infancy, depleting “the most valuable asset for the future progress of our race.” The article concluded that the “only remedy for this fearful drain on the pick and flower of our young womanhood and manhood is a widespread inculcation of the

94 Emmett Scott and Monroe Work to Booker T. Washington, undated, 237, “1915,” “Records and Research, Work, Monroe Nathan,” reel 548, BTW, TA. 140 habit of clean surroundings and clean living.”95 Thus, the articles tied the race’s future to health improvement while supporting Washington’s philosophy of accommodation. One of the biggest reasons for this exorbitant mortality rate was that large numbers of working class and poor black women could not access prenatal care due to a combination of discrimination, limited availability, and lack of affordability. Instead of mentioning the discrimination that had the greatest effect on these statistics, the articles concentrated on self-help and what blacks could do.

After scaring parents and leaders about the future of the race, later Tuskegee publication suggestions focused on the present. Finding that 16 out of every 100 blacks died of TB, Washington noted that the simple action of leaving windows open at night to allow in fresh air would save one-quarter, or 150,000 African Americans.96 In this way, the Week’s organizers emphasized not only ease of action, but also the immense impact such small acts could have. Again, these were not new suggestions. Many periodicals suggested the same activities for poor white and European immigrants.97

The articles also illustrate the second strategy for promoting grassroots organizing, and the most important recommendation that Scott and Work made: giving the public the information to organize the Week on its own. While NHW’s leaders provided

95 “Plans for Observance of National Health Week,” Baltimore Afro-American, February 20, 1915, 6; “Dr. Washington Gives Reasons for Health Week,” The Chicago Defender, February 6, 1915, 1; “Some Reasons for Having a National Negro Health Week,” 932, “National Negro Health Week,” reel 713, BTW, TA.

96 “Combat the Monster: Consumption,” March 8, 1915, 941, “National Negro Health Week,” reel 713, BTW, TA.

97 See for example, “The Trend of Things,” The Survey: Social, Charitable, Civic: a Journal of Constructive Philanthropy (The Survey) 24(15) July 9, 1910: 590-595, 593; “Some Things American Cities Do Not Know,” The Survey 35(3) October 16, 1915: 57. 141 suggestions for programming to the groups it partnered with, it also asked newspapers to publish the Week’s agenda so that anyone could organize a program.98 Therefore, the

Week’s organizers had to make NHW tasks as straightforward as possible to create a coherent campaign. The program, much of it taken from the Negro Organization Society of Virginia, targeted specific activities that poor people, particularly those in the rural

South, could accomplish in their limited spare time. Instead of recommending a checkup with a physician or getting vaccinated like other campaigns, the Week stated six goals:

(1) Removing and burning trash; (2) Dusting furniture; (3) Cleaning and painting walls, ceilings, and floors; (4) Cleaning the yards; (5) Repairing any stables or barns; (6)

Keeping wells and outhouses in clean and working order.99 All of these goals were straightforward, required little expenditure, and could be completed by African

Americans of all classes with little to no outside help.

The Week’s aims also reflected Washington’s interest in ensuring that whites could easily recognize the Week. Three of the six goals had to do with outward appearance, what passers-by could see: the painting of walls and fences, yard cleaning, and the repairing of stables, barns, and hen-houses. For Washington, the more obvious the improvements, the more likely whites were to think better of blacks.

98 Emmett Scott and Monroe Work to Booker T. Washington, undated, 237, “1915” “Records and Research, Work, Monroe Nathan,” reel 548, BTW, TA; “National Negro Health Week Program,” 928, “National Negro Health Week,” reel 713, BTW, TA; “National Health Week Program,” The Chicago Defender, March 6, 1915, 2; “Observe Health Week,” Christian Recorder, March 15, 1915, “THC, 1915,” 220, TA.

99 “National Negro Health Week Program,” 928, “National Negro Health Week,” reel 713, BTW, TA; Virginia Health Bulletin, 6(2) April 10, 1914, Virginia Department of Health, 69, 468, “Moton, Robert Roussa, 1914” reel 61, BTW, TA. 142

In addition to the announcements about NHW the “Tuskegee Machine” sponsored,

Work used yet another strategy to promote grassroots organizing. He created a 15 page bulletin for observing the Week to provide local leaders with a template to formalize health practices and ensure similarity in grassroots participation.100 While pamphlets, as the NTA found, could be expensive and difficult to distribute, the grant Washington received from the Phelps-Stokes Fund, combined with the distribution networks of the

NNBL and other groups, made the pamphlet a logical tool. The brochure edited by

Monroe Work and titled “The Conservation of Negro Health,” (the Bulletin) began with

Washington’s call to observe the Week and included all of Tuskegee’s NHW press releases.101 After reinforcing the importance of the campaign, the Bulletin noted that the

African American death rate had decreased, meaning that black health had improved.

Here, the Bulletin portrayed the African American community as already involved in improving its own health and NHW was an extension of this effort, not a new and different one.102

The Bulletin also included a section heading that read: “The White People Will Co- operate with Us in This Clean-up Movement.”103 Here the Bulletin argued, as had

Washington and others, that whites knew of the connection between white and black

100 Guzman, “Monroe Nathan Work and His Contributions,” 452.

101 “In Memoriam: Dr. Monroe N. Work, Tuskegee Institute, Ala.,” National Negro Health News 13(2) 1945: 24; “The Conservation of Negro Health,” 1-6, 829-832, “National Negro Health Week,” reel 713, BTW, TA.

102 “The Conservation of Negro Health,” 7, 832, “National Negro Health Week,” reel 713, BTW, TA.

103 “The Conservation of Negro Health,” 7, 832, “National Negro Health Week,” reel 713, BTW, TA. 143 health. Therefore, blacks working on their own health issues could expect some support from whites. While this interracial work was an important element, the vast majority of the financial support African Americans sought for the Week went towards improving black health.

After emphasizing the cross-racial interest of health, the Bulletin turned its attention to the Week’s goals. Here, it first made an overture to ministers, asking them to dedicate

Sunday, March 21 to “prayer for better health conditions.”104 As this chapter will discuss later, many ministers from a variety of Christian sects acquiesced to the Bulletin’s request. The support of the Christian Recorder was particularly noteworthy, asking ministers to attack the “fallacy about [how] people ‘must die when their time comes,’ and putting the responsibility of all their deaths upon the Lord, saying ‘the Lord giveth and the Lord taketh away.’”105 Instead of this impotent attitude, the Recorder advised ministers to find scriptures that emphasized the importance of health, such as “Know ye not that your bodies are the temple of the Holy Ghost.”106 The Recorder’s advice was similar to that of the NTA on TB. The journal also asked ministers to give sermons and use their influence to recruit speakers and aid in the organization of local NHW committees. Here, the Week’s organizers gave significant leeway. Although scheduled from March 21 to 27, local leaders had the authority to decide when and how to participate. Permitting communities to participate earlier or later gave them needed flexibility and autonomy to join in the Week.

104 “The Conservation of Negro Health,” 7-8, 832-833, “National Negro Health Week,” reel 713, BTW, TA.

105 “Observe Health Week,” Christian Recorder, March 15, 1915, “THC, 1915,” 220, TA.

106 “Observe Health Week,” Christian Recorder, March 15, 1915, “THC, 1915,” 220, TA. 144

The Bulletin also provided the Week’s local organizers with detailed health advice to instill formal hygiene and cleanliness practices. As Monroe Work explained, “the bulletin was intended for the layman – to give information and inspiration – so that any one[sic] who got hold of it could use it.”107 Unlike the newspaper articles, which simply advised participants to make houses, churches, and outhouses “sanitary,” the Bulletin provided specific explanations as to how to achieve these goals and why they were necessary.108 In its discussions, it concentrated on easy to understand language with clear examples. One did not need a doctor, minister, or any member of the elite to follow its health advice. For example, “in scrubbing the floors, use strong lye and hot water,” and “add one quart of slat to five gallons of whitewash,” to get the perfect mixture.109 In this way, the Week began to help African Americans identify what the term “clean” meant and how to achieve it. Similarly, the Bulletin gave detailed instructions as to how to create a toilet, how to make the toilet sanitary, and how to maintain it. This information was particularly important considering that many rural African American homes lacked proper waste facilities. Even around Atlanta, less than 50% of African American homes had privies.110

Like the Bulletin’s advice for scrubbing, its recommendations for human waste stressed simplicity. It suggested placing topsoil next to the toilet that the user could put

107 “Negro Health Week Conference,” 8, folder 2, box 1, National Negro Health Week Collection (NNHW), TA.

108 “National Negro Health Week Program,” 928, “National Negro Health Week,” reel 713, BTW, TA; “The Conservation of Negro Health,” 8-10, 833-834, “National Negro Health Week,” reel 713, BTW, TA.

109 “The Conservation of Negro Health,” 8-9, 833, “National Negro Health Week,” reel 713, BTW, TA; “National Negro Health Week Program,” 928, “National Negro Health Week,” reel 713, BTW, TA.

110 Fort, “The Negro Health Problem in Rural Communities,” 191. 145 on top of each waste deposit, having a sealed lid atop the toilet to prevent flies, and depositing the toilet’s waste away from water sources in a covered hole.111 Again, the

Bulletin’s recommendations all involved low-cost solutions that emphasized routine.

They also sought to change the understanding of what it meant to be “sanitary” by explaining the specific problems with previous methods. Simply put, not following these steps led to flies which bred disease. Additionally, the Bulletin connected the concept of impure water with typhoid and human waste with a variety of diseases, helping African

Americans understand the concrete benefits of the Week’s proposals.112

African Americans were not alone in trying to understand proper hygiene and sanitation. White civic associations, settlement houses, and charities all promoted similar techniques and understandings of proper health to the white poor and Eastern European immigrants. The Survey, a journal for philanthropists and charities focused on helping these populations, included clean yards and the use of lye as popular topics of discussion.113 The subject of clean privies also received considerable attention. The

Survey included pictures of poorly maintained privies as well as detailed descriptions of what made them unsatisfactory. Like the Bulletin, a privy was not to be “exposed, presenting opportunity for fly and other contamination.” The Survey explained that these

111 “The Conservation of Negro Health,” 10-11, 834, “National Negro Health Week,” reel 713, BTW, TA.

112 “The Conservation of Negro Health,” 9, 833, “National Negro Health Week,” reel 713, BTW, TA.

113 On the importance of a clean yard, see for example “The Common Welfare,” The Survey 24(1) April 2, 1910: 3-11, 6; “The Common Welfare,” The Survey 24(4) April 23, 1910: 127-134, 132; Lilian V. Robinson, “Civic Hygiene,” The Survey 24(26) September 24, 1910: 875- 877, 877. On the importance and use of lye, see for example L. T. Rhoades, “Important Sanitary Notice,” The Survey, 30(3) April 19, 1913: 122; Flora Spiegelberg, “To the Editor,” The Survey 27(11) December 16, 1911: 1390. 146 flies were not just simple pests but that they “later enter the houses to infect the food.”

Likewise, poor privy construction could allow germs to get into nearby well water or increase the risk of hookworm disease which depends on “the eggs in the fecal discharges…developing into worms, which can reinfect the patient or other people.” The point was to emphasize, like the Bulletin, the need for sanitary privies, and how to create them so that charity workers could teach (and enforce) “proper” practices to the poor whites and immigrants in need.114

That African Americans and European immigrants both focused on similar health practices was not surprising. The two groups found themselves in similar situations in the early 1900s. Native white discrimination and limited educational opportunities combined to restrict the income of both groups, leaving them to live in the worst conditions and to face the foulest variety of environmental and health hazards. Both groups had limited access to civic services and medical professionals. Given this situation, and the racism and anti-immigrant spirts of native whites, both groups looked for cheap ways to maintain good health.

In addition to simple cleaning and dusting, whitewash was one such method. Cheaper than paint, its main ingredient, lime, could be obtained for as little as 30 cents for 70-80 pounds. Lime had important properties. It worked as a disinfectant, insecticide, and odor disguiser. When added to water, lime prevented bacterial growth and could protect the material underneath, allowing wood houses a longer life.

114 Morris Knowles, “Water and Waste: The Sanitary Problems of a Modern Industrial District,” The Survey 27(14) January 6, 1912: 1485-1500, especially 1489, 1497-1498. 147

Whitewash required just lime and water, making it both simple to make and apply. It also provided houses with a clean look that often made them look more attractive. While it needed to be renewed more often than paint, rewhitewashing renewed the benefits of the whitewash, in addition to giving the house a new white coat.115 Whitewash’s utility, low cost, and easy access made it a perfect point of emphasis for a Week attempting to instill health practices in a group that did not have regular access to medical professionals.

Flies also received attention from both groups. Flies spread a wide range of diseases including typhoid, cholera, dysentery, and tuberculosis. While communities led campaigns around swatting flies and improving education about the fly menace, another method was to eliminate fly breeding places.116 In Cleveland, leaders of the anti-fly campaign asserted that “90 per cent of house-flies come from unclean stables.”117 As such, basic cleaning became more than just a way to make an area look nice. Removing smelly trash from a yard and properly caring for outhouse waste were now acts that had a great deal of importance since they would improve health.

To aid local organizers, the Bulletin included addresses to which blacks could write for more health information, but the listings undermined the idea of a pan-African

American campaign. The Bulletin’s recommendation to seek help from local health

115 Sloane Taliaferro, “Documentation and Testing of Nineteenth-Century Limewash Recipes in the United States,” master’s thesis, Columbia University, New York City, NY, 2015, 6- 11. On page 6 Taliaferro explains that “limewash” and “whitewash” are used interchangeably.

116 See for example Constance D. Leupp, “The Motion Picture as a Social Worker,” The Survey 24(22) August 27, 1910: 739-741.

117 “New Efforts for a Flyless City,” The Survey 30(21) September 16, 1913: 635-638, 635. 148 officials, usually white, would encourage greater biracial work and hopefully financial support for the movement. Yet the only African American group it listed for health information was the Tuskegee Institute, omitting the NMA and the NACGN.118 Although

Washington and Monroe Work wanted these groups to participate in NHW, not including them as information sources illustrated Washington’s interest in controlling the Week’s message.

The final page of the Bulletin included the Negro Organization Society of Virginia’s advice for healthy living, titled “Cautions for Good Health.” The elements listed to achieve good health included bathing, proper toilet use, pure water, and fresh air. Again, all of these actions required little cost and minimal effort. Even when discussing TB, the

Bulletin’s emphasis was not on seeing a physician, which was impossible for the vast majority of African Americans. The Bulletin advised instead that “to overcome consumption, nothing is so important as abundant fresh air.”119 Indeed, in the entire pamphlet, only one item appeared related to established medical treatment. The advice

“Be vaccinated as soon as possible,” appeared on the list of 19 ways to maintain health, buried in the middle at number 11.120

For Washington and Work, and in contrast to medical professionals, the term

“healthy” most nearly meant “cleanliness.” This again was similar to the white

118 “The Conservation of Negro Health,” 14, 836, “National Negro Health Week,” reel 713, BTW, TA.

119 “The Conservation of Negro Health,” 6, 832, “National Negro Health Week,” reel 713, BTW, TA.

120 “The Conservation of Negro Health,” 15, 836, “National Negro Health Week,” reel 713, BTW, TA; “The Conservation of Negro Health,” 6, 832, “National Negro Health Week,” reel 713, BTW, TA. 149 progressivism of the early twentieth century that stressed the importance of cleaning up tenements and teaching European ethnics from Southern and Eastern Europe the importance of presentation. The goal of these progressives was for these immigrants to eventually gain acceptance as being white and American. Somewhat similarly,

Washington and Work’s goal was to gain acceptance for persons of African descent as being American and equal. As such, a “healthy” person was one who had no visible dirt, grime, or filth on his or her skin. Similarly, a “healthy” home was one without peeling paint or trash in the yard and had a clean bathroom or outhouse nearby.

The omission of advice regarding specific medical practices or treatment empowered participants. In short, one did not need to consult a doctor to improve one’s health. While there were many elements that made up health and healthy people, Washington and Work emphasized one’s ability to address the environmental conditions poverty created as a primary catalyst for health improvement. This focus coincided with Washington’s and

Moton’s previous emphasis on cleaning up, but categorized scrubbing and dusting as activities that not only bestowed beauty, but also improved health. As the historian

Michele Mitchell explains, such views aligned with the greater “black discourse about domestic spaces [which] maintained that the weal or woe of African Americans was bound up in the purification of home environments.”121 The Week’s conception of health permitted anyone, regardless of wealth, to realize a modicum of “proper” health in the context of the campaign’s focus of empowerment.122

121 Mitchell, Righteous Propagation, 148.

122 Brundage, “Reconsidering Booker T. Washington and Up From Slavery,” 9. 150

The Public Reaction to the Call

Washington’s call received more interest in the South than the North for several reasons. First, Tuskegee, the home base of the Week, was in the South, as were most

African Americans. Of the almost 10 million blacks living in the U.S. in 1900, about 90% lived in the rural South.123 Second, Tuskegee Institute’s location in Alabama gave it great influence in the South. Third, as discussed earlier, a variety of cities in the South, not to mention much of Virginia, had already participated in clean-up days or weeks. All these conditions permitted the Week to quickly find traction in the South.

In the North, passion for the Week varied. While both the Philadelphia Tribune and the Chicago Defender published Washington’s calls for observing Health Week, only

Chicago’s blacks participated enough to get media coverage even though Philadelphia’s black population of 84,000 was almost twice that of Chicago’s.124 Many factors contributed to this difference. One was that, as discussed earlier, not all African

Americans accepted Washington’s accomodationist views. To control his message and promote his vision, as well as attack his opponents, Washington enlisted the aid of a number of northern and western white philanthropists to provide funds to purchase numerous black newspapers. Among these papers was the Chicago Leader, which ran a

123 U.S Bureau of the Census, Statistical Abstract of the United States, 1926 (Washington, D.C.: U.S. Department of Commerce, 1927), 13; U.S Bureau of the Census, Statistical Abstract of the United States, 1910 (Washington, D.C.: U.S. Department of Commerce, 1910), 45; Robert Gregg, Sparks from the Anvil of Oppression: Philadelphia’s African Methodists and Southern Migrants, 1890-1940 (Philadelphia, PA: Temple University Press, 1993), 13.

124 Roberts, Jr., Infectious Fear, 9-10; John F. Bauman, Public Housing, Race, and renewal: urban Planning in Philadelphia, 1920-1974 (Philadelphia, PA: Temple University Press, 1987), 12-13; Davarian L. Baldwin, Chicago’s New Negroes: Modernity, the Great Migration, and Black Urban Life (Chapel Hill, NC: University of North Carolina Press, 2007), 23; St. Clair Drake and Horace R. Cayton, Black Metropolis: A Study of Negro Life in a Northern City (New York, NY: Harcourt, Brace and Company, 1945), 8-9. 151 number of articles in support of Washington. However, he was unsuccessful in purchasing influence in Philadelphia, which remained solidly against his accomodationist philosophy.125

Another factor was that some of the Chicago newspapers themselves, such as the

Chicago Defender, had made health a priority in the past. The newspaper had promoted public lectures on health and provided regular column inches to Dr. A. Wilberforce

Williams’ “Keep Healthy” column.126 From this perspective, the Defender’s editors could view Washington’s Health Week declaration as confirmation of their work and priorities.

A perception of NHW as an endorsement of their efforts might have led the editors to publicize NHW all the more. Indeed, the Defender published twice the number of articles on Health Week as the Tribune, indicating a greater interest in the Week.

Black periodicals promoting the Week used a variety of strategies in addition to publishing Tuskegee’s NHW press releases. Some used fear as a motivational tool. The

New York Age declared that “GERM LADEN old clothes, the SEPTIC drinking glass…cause the excessive infant mortality and consumption to ride rampant throughout the black race.”127 The Indianapolis Freeman put the high mortality and disease that could “ride rampant” through African American communities in more practical terms, “A

125 See Emma L. Thornbrough, “More Light on Booker T. Washington and the New York Age,” The Journal of Negro History 43(1) (January 1958): 34-49; August Meier, “Booker T. Washington and the Negro Press: With Special Reference to the Colored American Magazine,” The Journal of Negro History 38(1) (January 1953): 67-90; Harlan, Booker T. Washington: Volume 2, 96-106.

126 “Self Preservation,” Chicago Defender, February 13, 1915, 8. See for example: Dr. A. Wilberforce Williams, “Keep Healthy,” Chicago Defender, April 12, 1913, 4. This was a weekly column in the paper and ran under several other titles in the years that followed.

127 “National Health Week,” The New York Age, February 13, 1915, “THC, 1915,” 242, TA. 152 few years added to a life of a man can make a vast difference in his family. The children can be thrown across the danger line of helplessness within those few years.”128

According to the author, the issue of health had consequences not just for those dead or dying, but also for the healthy and living. This latter group faced the greatest impact of long-term ill health, and the little warning most families had from disease to death meant that even slight health improvements could go a long way towards generational stability.

Papers also emphasized the costs and savings involved in promoting health, a similar tactic to that of the NTA. Many imitated Work’s estimates about the expenses of caring for sick blacks, substituting their particular city or state’s figures to make the costs relatable to readers.129 The Christian Recorder used a similar tactic, but instead of calculating state expenditures, it calculated African American losses. Using Philadelphia as an example, the Recorder estimated that the city’s black population lost at least

$500,000 in annual wages each year due to health problems.130

Some periodicals took the opposite approach and focused on the economic benefits good health would produce in the future. Since insurance companies charged higher premiums for those they thought more likely to die, and used health statistics to inform their pricing, improved black health would lead to lower rates, saving the race money.131

The Christian Recorder argued that participation in Health Week could also create profit.

128 “A Health Week,” The Freeman, February 13, 1915, “THC, 1915,” 219, TA.

129 “An Economic Waste,” The Journal and Guide, February 13, 1915, “THC, 1915,” 231, TA.

130 “R. R. Wright, Jr., “Economic Loss Due to Sickness,” Christian Recorder, April 1, 1915, “THC, 1915,” 244, TA.

131 “A Health Week,” The Freeman, February 13, 1915, “THC, 1915,” 219, TA; Dr. Lloyd E. Bailer, “Health Hints,” Kansas City Sun,” March 20, 1915, in THC, 1915,” 248, TA. 153

The Recorder explained that in cleaning up, “…many valuable things which have been hidden and thought lost will be found. We had a ‘clean up day’ in our little office, and recovered $10 worth of valuables we thought were lost.”132 The Recorder also encouraged recycling, at least to an extent, urging people to sell the trash, old bottles and random scraps of iron they removed from their houses.133

Other papers focused on the less tangible benefits of improved health. The Freeman observed that “sanitary care, would prolong his [African Americans] years thus proving an inestimable blessing to his posterity, and the human race as a matter of influence.”134

Parents who took better care of themselves would miss less work, be more productive members of the labor force, and thus be able to provide enhanced care for their children.

Others emphasized the health progress blacks had already made. Here, they struck similar chords to some of Washington’s NHW press releases, asserting that while health statistics for blacks were worse than for whites, they had improved.135 That African Americans had already made strides to progress their health meant improvement was possible, and the organization of such an effort would, theoretically, enhance these efforts.

Yet while the implied message in all the articles was that better health would generate greater black wealth and prosperity, they all overlooked the most significant cause of their plight. Left unmentioned was the institutional racism that relegated them to living in unhealthy neighborhoods, limited their access to medical treatment, and generally

132 “Observe Health Week,” Christian Recorder, March 15, 1915, “THC, 1915,” 220, TA.

133 “Observe Health Week,” Christian Recorder, March 15, 1915, “THC, 1915,” 220, TA.

134 “A Health Week,” The Freeman, February 13, 1915, “THC, 1915,” 219, TA.

135 “Health and the Negro,” Unnamed journal, undated article, “THC, 1915,” 224, TA; “An Economic Waste,” The Journal and Guide, February 13, 1915, “THC, 1915,” 231, TA. 154 restricted their ability to improve their socioeconomic status. As per Washington’s philosophy, the vast majority of NHW articles did not challenge the status quo. They did not advocate political activity against these institutions, but settled instead on the few self-help activities African Americans could pursue.

To supplement the feeling of a race united in its health improvement work, the papers published the plans of other local committees. For instance, The Norfolk Journal and

Guide, based in Norfolk, Virginia, reported on activities as far away as Fayetteville,

North Carolina, 223 miles away.136 The Dallas Express discussed Health Weeks throughout the state of Texas, reporting on those in Houston, Galveston, San Antonio,

Fort Worth, Austin, and Waco.137 This reporting implied a bit of peer pressure, suggesting it was out of step not to participate in a Week with such wide appeal.

While most white newspapers did not report on the Week, a few in the South not only took notice, but also encouraged their readers to participate. But instead of discussing

Christian values or the benefits of philanthropy, these papers concentrated on the interracial aspects of health. Specifically, how the health of one race affected the health of the other. This concept was of great importance to white Americans, particularly the middle class and elite who came in some contact with blacks – the majority of whom were servants. As The Atlanta Constitution put it, “It is criminal ignorance and folly in this connection to preach that we are not ‘our brother’s keeper.’ Theoretically, we may not be, but when we come in contact with him we inherit the penalties of his physical

136 “Health Week at Normal,” The Journal and Guide, April 10, 1915, “THC, 1915,” 223, TA.

137 “Health Week at Dallas,” Dallas Express, March 4, 1915, “THC, 1915,” 243, TA. 155 shortcomings.”138 Another Southern paper put it a bit more politely, “A cook may be ever so clean and decent in person, but if she live in squalid and foul surroundings she may be the innocent victim and carrier, too, of disease.”139 Although segregation could separate the races in terms of where they lived or how they interacted, the fact that the races interacted with each other raised the specter of germ transfer, “since the germ does not respect the color line…”140 Therefore, out of pure self-interest to maintain the white race’s own health, these papers concluded that whites should support the Week.

After convincing the African American public of the need to address health concerns, the next task was to organize local committees. While NHW leaders published pamphlets and set a general agenda, they did not have enough financial resources at their disposal to set up a local committee in every community. Although the Bulletin included general suggestions on leadership groups, each community had the freedom to choose who should lead the local NHW and the press’ suggestions on leadership demonstrated little consensus. Some encouraged physicians to control the Week. These papers mimicked much of the NTA’s reasoning for building the TB movement around doctors. They argued that the issue of health suited physicians and it would allow them to “show their public spirit and their interest in the people as a whole.”141 The papers based this argument on the idea that, regardless of race, doctors mostly concerned themselves with

138 “Self-Preservation,” The Atlanta Constitution, March 18, 1915, “THC, 1915,” 239, TA.

139 “‘Clean-up Day’ and the Negroes,” unknown publication, March 30, 1915, “THC, 1915,” 239, TA.

140 Self-Preservation,” The Atlanta Constitution, March 18, 1915, “THC, 1915,” 239, TA.

141 “The Health Week,” unknown publication, March 11, 1915, “THC, 1915,” 242, TA; Dr. Lloyd E. Bailer, “Health Hints,” Kansas City Sun,” March 20, 1915, in THC, 1915,” 248, TA; “Health Week at Dallas,” Dallas Express, March 4, 1915, “THC, 1915,” 243, TA. 156 treating, and then charging the sick. The high cost of this treatment often left patients with mixed emotions about physicians. Participating in the Week would allow doctors to show their altruistic side, and would also help make blacks more comfortable with them and less interested in alternative folk medicine. However, the small number of black doctors in 1915 meant they could not lead every community’s Week. Furthermore, not all physicians heeded the call and most were not active organizers.

Other papers expanded on the Bulletin in asking ministers and churches to organize the Week. The press used religious rhetoric to encourage minister buy-in, calling participating in the Week a “sacred obligation,” or noting that communities needed to

“invoke the aid of Almighty God to help us infuse in the minds of our people the importance of taking care of their bodies and observing the great laws underlying health.”142 Calling on G-d for help in conducting the Week made sense in the context of the deaths that poor health caused. The St. Louis Argus even cited scripture to persuade ministers of the religion-health connection, “Who shall ascend into the hill of the Lord, or who shall stand in His holy place? He that hath clean hands and a pure heart.”143 The paper depicted health as a vital component of a minister’s responsibility to lead the members of his congregation to heaven. Others advocated for a committee made up of local leaders of the church, mutual aid societies, and secret societies. The thinking here was that the societies’ experiences caring for their own sick members made them well- prepared to improve the community’s health. However, given the status of African

142 “National Health Week,” St. Louis Argus, March 19, 1915, “THC, 1915,” 230, TA; “National Negro Health,” Atlanta Independent, March 20, 1915, “THC, 1915,” 220, TA.

143 “National Health Week,” St. Louis Argus, March 19, 1915, “THC, 1915,” 230, TA. 157

American ministers in the overall society, it was possible for them to bring disparate groups together to discuss ways of working together to improve community health.144

The extension of church leaders working with mutual aid societies illustrated one of the important factors that weighed on organizing a Health Week, money. Much of the search for leaders of local committees had to do with a search for funds. The national black organizations that the Week’s organizers recommended locals look to for participation represented some of the more well-organized and funded groups supporting

African American interests. Where these organizations had little influence, a local committee needed others to contribute resources. Local and state health departments provided a good alternative to black institutions. These departments already had funding and their mission was similar to that of the Week. Additionally, the Week’s emphasis on the economic effect of black health and the connection between black and white health encouraged cooperation.145 This interracial work would also further cement the use of the newly formed public health agencies that had appeared in the South as part of the fight against hookworm.146 Unfortunately, throughout the South, the majority of social and state organizations allocated very little funding to black organizations or institutions.

144 “The Observance of National Negro Health Week,” Atlanta Independent, February 27, 1915, “THC, 1915,” 222, TA; “National Negro Health,” Atlanta Independent, March 20, 1915, “THC, 1915,” 220, TA.

145 “An Economic Waste,” The Journal and Guide, February 13, 1915, “THC, 1915,” 231, TA; “The Colored Health Association’s Conference,” unknown publication, March 25, 1915, “THC, 1915,” 239, TA.

146 “Health Department Will Aid Clean-up Week,” The Journal and Guide, March 13, 1915, “THC, 1915,” 230, TA. For more on hookworm and its expansion of public health agencies, see Ettling, The Germ of Laziness. 158

Such institutional racism meant that blacks had to choose their words carefully in order to convince white-led groups to provide funding for a black health campaign.

Newspapers asking organizations to participate framed such requests in the language of Washington’s accomodationist philosophy. They noted how participation fulfilled the missions of the organizations and proposed supporting the Week as a way to enhance white health. They explained how the health issues blacks faced affected whites, and then argued that while blacks worked to improve themselves, “…progress will be slow unless the State takes a more active part in the work.”147 Many municipal and state health departments responded to these requests. As Dr. Charles Frederick Boldman, director of the health department of the Public Health Education Bureau in New York City explained, “If we [health officials] can teach them [blacks] how to live under more sanitary conditions…we will have the tuberculosis scourge by the throat.”148 Tolerating such paternalistic attitudes was easier if they came with resources.

Although African Americans wanted white support, The Norfolk Journal and Guide wrote that “Colored people do not ask nor expect the State to do for them what they can do themselves.”149 The paper emphasized the hard work and self-help Washington preached in encouraging blacks to prove their worth to whites. Requests for white help even took a supportive tone towards white paternalism, “We have no doubt that the health authorities of the State and the city will gladly advise and direct….the colored

147 “An Economic Waste,” The Journal and Guide, February 13, 1915, “THC, 1915,” 231, TA.

148 “It’s Health Week for the Negroes,” Morning Star, March 22, 1915, “THC, 1915,” 225, TA.

149 “An Economic Waste,” The Journal and Guide, February 13, 1915, “THC, 1915,” 231, TA. 159 people in the work for health,” even if that work “should be of the utmost concern to all people without regard to color.”150 Again, Washington’s voice rings through these articles. African Americans were not attempting to change America’s social structure and recognized the help whites could give blacks. African Americans understood their place; they just wanted aid in making that place the best it could be.

While the Week found widespread support from black newspapers and journals, some expressed consternation regarding the Week’s execution and interest. The Indianapolis

Freeman questioned the race’s ability to cooperate together to improve its welfare. The paper argued that smaller-scale projects with tangible outcomes were easier issues for organizing the race.151 Another concern involved how to connect with the people most in need of health information. The Baltimore Afro-American, like the NTA, argued that most newspaper articles and meetings about health did not reach the poorest of the race, those least able to purchase newspapers, and who lacked the time, or inclination, to attend meetings. As the Afro-American put it, many poor blacks “are satisfied to sit still and let the world move along the same until they are victims of tuberculosis or some other contagious disease.”152 As discussed earlier, organizers had to make a determined effort to ensure that their health message reached all African Americans, not just the elite.

Armed with the name of Booker T. Washington and health practices that were easy to understand and implement, that empowered participants to improve their health without seeing a physician, NHW leaders inaugurated the Week on March 21. The variety of the

150 “‘Clean-up Day’ and the Negroes,” unknown publication, March 30, 1915, “THC, 1915,” 239, TA.

151 “National Negro Health Week,” The Freeman, June 12, 1915, “THC, 1915,” 249, TA.

152 M.A.B., “A Health-Week Suggestion,” Baltimore Afro-American, March 13, 1915, 6. 160

Week’s health messages and methods of dissemination illustrated the diversity of the

Week’s leaders and participants, as well as the utility of allowing locals to decide how to join in the campaign.

NHW in 1915 – Local Leadership

Leadership in local Weeks varied widely. In cities that had held clean-up weeks in the past, there was already a natural leadership. The Health Departments of Atlanta and

Montgomery arranged the Week’s activities in those cities, and the Negro Organization

Society of Virginia did the same throughout the state.153 However, given the breadth of the campaign, the publicity it received, and its association with Washington, organizers sought to expand their activities in 1915. In Atlanta, the Health Department asked for extra support and got aid from the YMCA, the Board of Trade, the Anti-Tuberculosis

League, and the City Federation of Women’s Clubs.154 In Virginia, the Society worked with Virginia’s Board of Education and partnered locally with Norfolk’s Health

Department and Social Service Bureau.155 In Dallas, which did not have clean-up experience, the Dallas Express worked with the city’s Negro Medical Society, local

153 “Spring Clean-up to be Held Here on May 10 to 15,” Advertiser, March 18, 1915, “THC, 1915,” 225, TA; “All Forces Unite for Big ‘Clean-Up Week’ in Atlanta,” The Atlanta Constitution, March 28, 1915, “THC, 1915,” 232, TA.

154 “All Forces Unite for Big ‘Clean-Up Week’ in Atlanta,” The Atlanta Constitution, March 28, 1915, “THC, 1915,” 232, TA; “National Negro Health Week Auspicious,” Atlanta Independent, March 27, 1915, “THC, 1915,” 236, TA; “Program Health Week,” Atlanta Independent, March 20, 1915, “THC, 1915,” 237, TA. In the early 1900s YMCA’s promoted the gospel of germs. See Tomes, Gospel of Germs, 186.

155 “Clean-up Days Next Week,” The Journal and Guide, April 10, 1915, “THC, 1915,” 237, TA; Robert Moton to Booker T. Washington, March 22, 1915, 552, “Moton, Robert Russo 1915,” reel 61, BTW, TA. 161 churches, and even the American Medical Association (AMA) to arrange speakers and space for talks.156

Indeed, leadership of the Week often consisted of a combination of agencies and individuals. In New York City, the National Urban League, the New York Board of

Health, various ministers, private doctors, and a few other leading citizens all worked together on the Week.157 In Savannah, Georgia, the National Urban League hosted speakers from local churches, the South Atlantic Medical Association, and City Health officials.158 Shared leadership meant limited costs for each participating organization while shining Washington’s spotlight on each group, helping organizations generate new interest and publicity.

Although the NHW leadership did not contain any female members, women played an important role in local Weeks, as they had in past efforts to improve the race.159 In

New York City, Baltimore, Norfolk, and Muskogee, Oklahoma, women participated as private citizens rather than as part of women’s groups. These women served on various local NHW committees, helping to organize street cleaning and other sanitary and clean-

156 “Everything Ready For ‘Health Week’ March 21,” Dallas Express, March 20, 1915, “THC, 1915,” 246, TA; “Dallas Local,” Dallas Express, March 27, 1915, “THC, 1915,” 238, TA.

157 “Local Health Campaign,” New York News, March 26, 1915, “THC, 1915,” 231, TA; “It’s Health Week for the Negroes,” Morning Star, March 22, 1915, “THC, 1915,” 225, TA; “Leading Citizens Asked to Promote Health Week Here,” New York Age, March 11, 1915, “THC, 1915,” 249, TA. The New York Amsterdam News also lists a variety of groups that had much smaller roles, “Urges Health Week,” March 19, 1915, “THC, 1915,” 221, TA.

158 “Health Week Begins Monday,” Savannah Tribune, March 20, 1915, “THC, 1915,” 238, TA; “Negro Health Week Program Attracted Wide Attention,” Savannah Tribune, March 29, 1915, “THC, 1915,” 218 TA.

159 See for example Mitchell, Righteous Propagation. 162 up activities, in addition to publicizing health talks.160 In Cairo, Illinois, leaders had physicians and nurses instruct small committees of men and women about important health topics. These co-ed groups, similar to Work’s Savannah efforts, then walked through the community to discuss health issues with people in a one-on-one format to provide direct and specific health advice.161

Many women’s organizations also volunteered their services. The NACW was instrumental in rallying women to the cause and providing resources to support the Week.

Of particular note was its work in Georgia, where the state’s NACW affiliate successfully got the governor to create a statewide cleanup week to follow up on NHW.162 Smaller women’s groups participated as well. The Mount Zion sisterhood led the Week in Peoria,

Illinois, while the ladies Missionary Society of the Dexter Avenue Baptist Church organized the final program of the Week in Montgomery.163 The program for the last day of Montgomery’s Week included a paper on infant mortality that a female doctor wrote.164 In Savannah, the women of the National Urban League ran one of the four days

160 “Clean-up Days Next Week,” The Journal and Guide, April 10, 1915, “THC, 1915,” 237, TA; “Leading Citizens Asked to Promote Health Week Here,” New York Age, March 11, 1915, “THC, 1915,” 249, TA; C. W. Maitland, “Go to Church Day Sunday, March 14,” The Chicago Defender, March 13, 1915, 2; “Will Hold a Health Exhibit,” Baltimore Afro-American, February 20, 1915, 7.

161 R. L. Campfield to Booker T. Washington, January 23, 1915, 7-8, “National Negro Business League,” “Folder C,” reel 757, BTW, TA.

162 “Clean-up Week,“ Montgomery Advertiser, March 18, 1915, “THC, 1915,” 227, TA; “All Forces Unite for Big ‘Clean-Up Week’ in Atlanta,” The Atlanta Constitution, March 28, 1915, “THC, 1915,” 232, TA

163 Elmer R. Price, “Woman’s Council Report Good Work for Entire Year,” The Chicago Defender, March 20, 1915, 2; “Health Week Comes to Brilliant Close at Dexter Ave. Baptist Church,” The Colored Alabama, April 3, 1915, “THC, 1915,” 223, TA.

164 “Health Week Comes to Brilliant Close at Dexter Ave. Baptist Church,” The Colored Alabama, April 3, 1915, “THC, 1915,” 223, TA. 163 of programming for the Week. Their program focused on women’s perspectives on health and included speeches by female leaders of social welfare organizations.165 Here again, the Week’s organizers demonstrated that women were vital to identifying the health concerns on which the Week should focus.166

NHW in 1915 – Talks and Physicians

Speeches, by physicians, pastors, and local leaders, were a popular way to celebrate the Week. Many of those lectures addressed broad health issues, such as the general status of African American health, why proper sanitation was so important, and the ways in which one could catch disease. Lectures took place not only at private organizational halls, such as the local Urban League, but also at churches and schools as leaders tried to ensure their message reached the largest possible audience.167

165 “Negro Health Week Program Attracted Wide Attention,” Savannah Tribune, March 29, 1915, “THC, 1915,” 218, TA.

166 For more on the participation of women throughout the life of National Negro Health Week, see Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890-1950 (Philadelphia, PA: University of Pennsylvania, 1995), especially 32-81.

167 “Urges Health Week,” New York Amsterdam News, March 19, 1915, “THC, 1915,” 221, TA; “Charge White Doctors Make Wrong Diagnoses,” The New York Age, March 26, 1915, “THC, 1915,” 226, TA; “Health Week in Chicago,” The Freeman, March 27, 1915, “THC, 1915,” 221, TA; “Health Week at Normal,” The Journal and Guide, April 10, 1915, “THC, 1915,” 223, TA; “Negroes Launch a Nation Wide Health Campaign,” The Picayune, March 25, 1915, “THC, 1915,” 223, TA; “Health Day at Princeville Graded School,” The Journal and Guide, April 13, 1915, “THC, 1915,” 225, TA; “Morris Brown University News,” Atlanta Independent, March 27, 1915, “THC, 1915,” 235; “It’s Health Week for the Negroes,” Morning Star, March 22, 1915, “THC, 1915,” 225, TA; “Two Bishops Stress Value of Sanitation,” The Atlanta Independent, March 25, 1915, “THC, 1915,” 245, TA; “News From Still Pond,” Baltimore Afro-American, April 3, 1915, 3; “Two Important Meetings for Colored People,” “A. Chatham and C. W. Massey, undated, March 1915, 943, “National Negro Health Week,” Reel 713, Booker T. Washington Collection, TA. 164

In addition to broad speeches on health, some addressed more specific topics, such as oral hygiene and improving the health of infants and young children.168 This second area of focus was of particular interest to NHW leaders. They noted infant death rates in both the Week’s Bulletin and in press releases. Speaking at Savannah, Georgia’s Week, Dr. C.

C. Middleton explained that there were five major reasons for the great mortality rate of black babies, “First, improper care of the mother before confinement. Second, improper care of the mother during and just after confinement. Third, improper care of the newly born infant. Fourth, improper feeding of the newly born infant. Fifth, disease.”169

According to Middleton, disease caused the least mortality. Like others, he argued that ignorance of proper health care was primarily responsible for infant deaths. In keeping with the NHW focus on black self-help, Middleton ignored the institutional racism that prevented black women from accessing medical care for themselves or their children.

Instead, Middleton and others agreed that new mothers needed better health education. Exactly what that education should look like was more contentious. The New

York City Department of Health set up extra milk stations during the Week. In addition

168 “Dental Don’ts,” Dr. A. H. Dyson, March 21-28, 1915, 888, “National Negro Health Week,” reel 713, BTW, TA; “Health Week – March 21-27,” Extension Department of Tuskegee Institute, March 21-27, 1915, 889, “National Negro Health Week,” reel 713, BTW, TA; “Negro Health Week Program Attracted Wide Attention,” Savannah Tribune, March 29, 1915, “THC, 1915,” 218, TA; “Health Week Comes to Brilliant Close at Dexter Ave. Baptist Church,” The Colored Alabama, April 3, 1915, “THC, 1915,” 223, TA; “Health Week Program at D Exeter Ave. Baptist Church,” The Colored Alabama, March 27, 1915, “THC, 1915,” 249, TA; “Packed House Hear Brilliant Artists Sunday,” Chicago Defender, March 27, 1915, 5; “Health Week Comes to Brilliant Close at Dexter Ave. Baptist Church,” The Colored Alabama, April 3, 1915, “THC, 1915,” 223, TA; “Health Week Program at D Exeter Ave. Baptist Church,” The Colored Alabama, March 27, 1915, “THC, 1915,” 249, TA; “Local Health Campaign,” New York News, March 26, 1915, “THC, 1915,” 231, TA.

169 Dr. C. C. Middleton, “‘Better Babies,’ An Address Delivered by Dr. C. C. Middleton at Health Week Observance at urban League Headquarters,” Savannah Tribune, April 3, 1915, “THC, 1915,” 240-241, TA. 165 to healthy milk, these stations provided instruction on how to properly feed, bathe, and maintain the cleanliness of, babies.170 This instruction was similar to that which immigrants received, who many worried “are ignorant as to how to wash milk bottles…or why the nipple from the milk bottle can’t be played with, fall on the floor and then be used.”171 Officials placed particular emphasis on nursing babies and only using bottles when mothers absolutely could not nurse, such as when they were at work.172 The goal of these milk stations was self-help: to empower mothers to properly care for their own children.

In Savannah, Dr. Middleton used a much different strategy to improve infant care, one that suggested another explanation as to why Washington did not closely align the

Week with the NMA. Middleton’s speech mainly gave anecdotes about women or children who died because they did not see a doctor. Instead of providing specific information on how new and expecting mothers might better care for their children, his speech emphasized relying on physician advice.173 Only those who paid a doctor’s fees could get knowledge about improving child care, an opportunity most African Americans did not have. In short, Middleton’s speech was an advertisement for physician utility,

170 “It’s Health Week for the Negroes,” Morning Star, March 22, 1915, “THC, 1915,” 225, TA; “Local Health Campaign,” New York News, March 26, 1915, “THC, 1915,” 231, TA; “Nation to Observe Negro Health Week,” unknown publication, unknown date, “THC, 1915,” 245, TA.

171 “Mabel Hyde Kittredge, “Housekeeping Centers in Settlements and Public Schools,” The Survey 30(5), May 3, 1913: 188-192, 190.

172 “Nation to Observe Negro Health Week,” unknown publication, unknown date, “THC, 1915,” 245, TA. Public health efforts towards immigrants also emphasized the proper use of bottles. See John Martin, “The Mother in Industry,” The Survey 35(25) March 18, 1916:720-722.

173 Dr. C. C. Middleton, “‘Better Babies,’ An Address Delivered by Dr. C. C. Middleton at Health Week Observance at urban League Headquarters,” Savannah Tribune, April 3, 1915, “THC, 1915,” 240-241, TA. 166 highlighting all the vital life-saving information they had. On one hand, there was a positive aspect to this kind of talk since African Americans were wary of doctors.

However, the emphasis on the deaths of children and the lack of specific information to aid in caring for the child was likely to scare mothers while providing them with no recourse. This was not self-help. According to Middleton, the only way to ensure a healthy baby was to hire an expensive physician. Middleton based his advice on two untenable assumptions, especially for the working class and poor in the rural South: the mother could afford a doctor; and a doctor would see an African American patient.

Middleton was not an outlier in his promotion of the importance of medical professionals during the Week. Most of these efforts focused on giving those usually unable to hear or interact with physicians the opportunity to get some health information.

These interactions had the potential to lay the foundation for improving the relationship between African Americans and the medical establishment. Some black physicians also used the week to counter the assumption that white doctors were superior to African

Americans. In Dallas, dentist A. H. Dyson created promotional materials for the Week that advertised his own services. He printed pamphlets with dental health “Don’ts” on them. Of the eight items he listed, two specifically focused on his own practice, “Don’t believe that you can get any better dental work done anywhere or that any dentist will treat you better than Dr. A. H. Dyson,” and “Don’t have your dental work done until you see Dr. A. H. Dyson. He guarantees his work to be the very best that can be done.” He 167 also, like Middleton, urged blacks to see dental specialists though, unlike Middleton, he advocated the use of black dentists in particular.174

Middleton’s speech illustrated another theme in the talks during the Week, that of

African American reliance on those outside of the medical establishment for treating maladies.175 For his example, Middleton used the “granny” or midwife. At the time, most midwives did not have a license or state certification and served those without access to medical professionals, such as European immigrants.176 The midwife’s credibility lay in her understanding of traditional medicine and her massive personal experience aiding women in labor. In taking on the granny, Middleton sought to attack traditional practices to elevate the medical establishment in the eyes of the African American community. To do this, he provided several anecdotes that illustrated how the granny’s lack of medical training endangered lives. Middleton accused grannies of not practicing proper sanitation, often delivering patients on dirty floors, and providing improper health advice. Middleton described one case in which a granny poisoned a child because she did not wash a glass prior to feeding the baby “and for over 48 hours the parents did not call medical attention,

174 “Dental Don’ts,” Dr. A. H. Dyson, March 21-28, 1915, 888, “National Negro Health Week,” reel 713, BTW, TA.

175 “Negro Health Week Program Attracted Wide Attention,” Savannah Tribune, March 29, 1915, “THC, 1915,” 218, TA; “It’s Health Week for the Negroes,” Morning Star, March 22, 1915, “THC, 1915,” 225, TA.

176 See for example “Report on the Midwives of Baltimore,” The Survey 22(11), June 12, 1909: 399. For more on black midwives specifically, see Onnie Lee Logan as told to Katherine Clark, Motherwit: An Alabama Midwife’s Story (New York, NY: E.P. Dutton, 1989); Margaret Charles Smith and Linda Janet Holmes, Listen to Me Good: The Life Story of an Alabama Midwife (Colubmus, OH: Ohio State University Press, 1996); Jenny M. Luke, Delivered by Midwives: African American Midwifery in the Twentieth-Century South (Jackson, MS: University of Mississippi Press, 2018). 168 because the granny said the baby would be all right.”177 Here Middleton reinforced the necessity of the Week’s emphasis on improving health knowledge as protection from the poor health advice black’s often received.

It is important to note that Middleton’s attack on the granny was part of the medical establishment’s concerted effort to control all aspects of health care. In the early 1900s, the U.S. had the third highest infant and maternal mortality rate in the world and midwives attended half of all U.S. births.178 There was no formal licensing or training for midwives to regulate their practices and due to the rural nature of the black population in the South, black midwives became particularly prevalent in this region. However, while the medical establishment blamed midwives for the high mortality rate and moved to regulate and license them, midwives were not responsible for these poor statistics.

Midwives filled a need in the health care system. The vast majority of the South consisted of poor blacks living in rural areas who, due to a combination of poverty, location, and racism, had little hope of getting a physician or licensed nurse to deliver a black baby.179

The granny was often the closest, cheapest, and most knowledgeable and available health care provider around. In the words of Alabama midwife Onnie Lee Logan, black midwives were “not doin it for a job but doin it as a person knowin there was need for it.”180

177 Dr. C. C. Middleton, “‘Better Babies,’ An Address Delivered by Dr. C. C. Middleton at Health Week Observance at urban League Headquarters,” Savannah Tribune, April 3, 1915, “THC, 1915,” 240-241, TA.

178 Logan as told to Clark, Motherwit, x.

179 Logan as told to Clark, Motherwit, 60; Luke, Delivered by Midwives, 4, 13-14.

180 Logan as told to Clark, Motherwit, 65. 169

Grannies understood the social, environmental, and economic problems their patients faced and worked with them to overcome their concerns during birth. Grannies knew that the poverty most blacks faced meant that black women would not be able to deliver in optimal conditions. Grannies used newspapers to pad down the floor so they would not slip and to protect the bed to catch the waste.181 This was a cheap way to improve the sanitation of what would soon become a delivery room. Unlike physicians and nurses, grannies stayed throughout the delivery process, which could take days. In addition to delivering the baby, they sometimes cooked and cleaned for the family, made clothes for the baby, and taught new mothers about basic infant care.182 By attending deliveries that otherwise would have left birthing mothers to fend for themselves these women undoubtedly saved many lives, both mother and child. Yet, as the historian and nurse- midwife Jenny Luke explains, “when viewed through the Eurocentric, patriarchic lens of a medical profession that placed scientific knowledge (macro level) above all other, they

[black midwives] were dismissed as incompetent, obsolete, and dangerous.”183 Combined with racial and gender biases about the poor intellect of African American women, white doctors moved to regulate and supervise African American lay midwives beginning in the early twentieth century.184

181 Smith and Holmes, Listen to Me Good, 85-93.

182 Logan as told to Clark, Motherwit, 90-97.

183 Luke, Delivered by Midwives, 14

184 Logan as told to Clark, Motherwit, x; Luke, Delivered by Midwives, 14. 170

Similarly, medical professionals also used the Week as an opportunity to attack the use of “patent medicine.”185 This again was not a specifically African American issue.

Frank Tucker’s presidential address at the 40th meeting of the national Conference of

Charities and Correction noted that “Social justice demands that the individual…be taught to spot a quack and shun him; to look askance upon patent medicine curealls.”186

As Dr. Hamilton of Dallas put it to African Americans during NHW, “Don’t waste your money on patent medicines: consult a doctor when ill – it will be cheaper in the long run.”187 Hamilton’s attention to the low cost of physician care in terms of long-term gain spoke to African American concerns about expenses, connected with the Week’s theme of linking health with finance, and indicated that at least some physicians understood the economic predicaments of their patients.

NHW in 1915 – Activities and Participation

Activities made up an important part of NHW’s efforts to improve black health education. Many of these activities started with children. The idea was to inculcate routinized practices around hygiene and sanitation as early as possible, when people were least set in their bad habits. In Atlanta, children from every school attended nearby churches to hear speeches from the Anti-Tuberculosis League and a black doctor. On

185 “It’s Health Week for the Negroes,” Morning Star, March 22, 1915, “THC, 1915,” 225, TA; “How to Keep Well,” Dr. Rich’d T. Hamilton, March 21-28, 1915, 887, “National Negro Health Week,” reel 713, BTW, TA; Dr. C. C. Middleton, “‘Better Babies,’ An Address Delivered by Dr. C. C. Middleton at Health Week Observance at urban League Headquarters,” Savannah Tribune, April 3, 1915, “THC, 1915,” 240-241, TA.

186 Frank Tucker, “Social Justice,” The Survey 30(14) July 5, 1913: 473-478, 476.

187 “How to Keep Well,” Dr. Rich’d T. Hamilton, March 21-28, 1915, 887, “National Negro Health Week,” reel 713, BTW, TA. 171 their way out, all children received a pamphlet on health.188 In Nashville, the Department of Education asked principals to bring in health speakers and reinforce the importance of health to teachers. The Department also set aside a “Clean Up Day” and invited parents to the school to help students whitewash and build out-houses.189 The idea was to impress upon the entire community the value of health, having everyone work together to improve the health of those most at risk, children. The Day also allowed children to put into practice what they learned in the lectures, internalizing the Week’s message, demonstrating their health comprehension, and displaying their proper health to passersby to stimulate greater participation.

Similar to the NTA’s stamp campaign, Tuskegee’s local organizers had children demonstrate their health knowledge by going house-to-house to distribute cards with tips on health. In this way, the entire Tuskegee community got the same health message about how to achieve better health, regardless of age or socio-economic status.190 The use of smiling children as the voices of this health movement ensured that the Week’s message received the best possible reception at each door the children knocked.

The Week’s efforts here echoed those of not only the NTA, but also of the charities trying to improve conditions for newly arrived immigrants. In Cleveland, where many public school children were Italian, “an effort is being made to make them the instructors

188 “Negroes Are Given Practical Lessons During Health Week,” The Atlanta Constitution, March 24, 1915, “THC, 1915,” 227, TA.

189 S. L. Smith and Samuel H. Thompson, “National Health Week Will Be Observed By The State Department of Education,” The Nashville Globe, March 5, 1915, “THC, 1915” 237, TA.

190 “Health Week in Macon County,” The Tuskegee Student, April 17, 1915, “THC, 1915,” 242-243, TA. 172 of household economy and sanitation in their own homes.”191 Girls received lessons on proper nourishment and cooking with the expectation that they would use what they learned to prepare meals at home and even teach their mothers. The Cleveland Board of

Education also worked with local dentists to create dental clinics in the school.

In addition to work with schoolchildren, many organizers mixed in a variety of events along with the lectures and talks that tended to make up the bulk of the Week. In Norfolk, organizers created contests with cash prizes for the best maintained properties. To stoke the competition, they provided cheap cleaning supplies.192 Savannah and Baltimore created health exhibits that taught proper health and sanitation.193 Baltimore’s exhibit also showed movies on “conditions that are disease-breeding, as well as those that make for health,” capitalizing on what social worker Constance D. Leupp of The Survey called “the newest ally of the ‘soldiers of the common good.’” 194

Social workers aiding immigrants also used movies that emphasized the same ideas about understanding disease-breeding conditions. One film focused on the environments flies enjoy and how they carry disease from “a foul cuspidore, then to the nipple on a

191 “Teach Dietetics Through Children,” The Survey 24(1), April 2, 1910: 6.

192 “Clean-up Days Next Week,” The Journal and Guide, April 10, 1915, “THC, 1915,” 237, TA; Part of Tuskegee’s Health Week also involved providing low cost cleaning supplies, see “Health Week in Macon County,” The Tuskegee Student, April 17, 1915, “THC, 1915,” 242-243, TA.

193 “Urban League Health Week March 22,” Savannah Tribune, March 6, 1915, “THC, 1915,” 228, TA; “Will Hold a Health Exhibit,” Baltimore Afro-American, February 20, 1915, 7.

194 “Will Hold a Health Exhibit,” Baltimore Afro-American, February 20, 1915, 7; Constance D. Leupp, “The Motion Picture as a Social Worker,” The Survey 24(22) August 27, 1910: 739-741, 739. 173 baby’s bottle.”195 As discussed earlier, the NTA used films to promote and popularize their cause, though the NTA’s efforts were more extensive due to greater funding.

Part of the reason for the assortment of activities had to do with worries that many public health campaigns had about reaching those most in need of comprehending proper health, the poor. In Norfolk, organizers encouraged the city’s sanitary inspectors to fine those who did not clean their yards and homes.196 Other organizers tried to make access to health information easier than attending time-consuming exhibits, talks, or films. One method was to hand out cards and small pamphlets on health that targeted one or two specific ways to improve home sanitation that those with few resources could apply.197

NHW partner organizations were often vital for this strategy with Boards of Health, schools, doctors, and other groups all creating material for their local populations.198

In terms of content, the cards, like the Week’s Bulletin, had simple, easy to follow messages. In Dallas, the cards stressed what not to do, starting each line of health advice with the word “Don’t.” Similar to basic health advice for newly arrived immigrants, they promoted the value of fresh air, washing hands regularly, and the need to watch out for flies due to the diseases they carried, “Don’t live in a house that is not WELL

195 Constance D. Leupp, “The Motion Picture as a Social Worker,” The Survey 24(22) August 27, 1910: 739-741, 739.

196 “Clean-up Days Next Week,” The Journal and Guide, April 10, 1915, “THC, 1915,” 237, TA; “Health Department Will Aid Clean-up Week,” The Journal and Guide, March 13, 1915, “THC, 1915,” 230, TA.

197 M.A.B., “A Health-Week Suggestion,” Baltimore Afro-American, March 13, 1915, 6; “The Conservation of Negro Health,” 7-8, 832-833, “National Negro Health Week,” reel 713, BTW, TA.

198 “It’s Health Week for the Negroes,” Morning Star, March 22, 1915, “THC, 1915,” 225, TA; “Dallas Local,” Dallas Express, March 27, 1915, “THC, 1915,” 238, TA; “Health Week in Macon County,” The Tuskegee Student, April 17, 1915, “THC, 1915,” 242-243, TA. 174

SCREENED.”199 The cards included simple language with easy to employ tips, and only basic explanations as to why such tips should be followed, “Lime will keep the toilet sweet and clean…Hot weather calls for much water inside and out.”200 Tuskegee’s cards focused on similar concerns, but also included clear and simple advice on diet, urging readers to “Eat less meat and more fruits and vegetable.” In addition, as with health messages to immigrants, the cards called for ending the use of tobacco and whiskey.201

Given Washington’s interest in interracial work, the first Health Week included some collaboration with whites. Participants in Dallas, Savannah, and Norfolk heard lectures by black and white speakers from a variety of backgrounds, including religious and charity leaders, physicians, health officials, and politicians.202 Yet, occasionally, the

Week could increase racial tension. The Week’s pamphlets and talks emphasized racial pride, taking pride in one’s appearance, in one’s health, in the exterior of one’s home, etc.

199 “Dental Don’ts,” Dr. A. H. Dyson, March 21-28, 1915, 888, “National Negro Health Week,” reel 713, BTW, TA; “How to Keep Well,” Dr. Rich’d T. Hamilton, March 21-28, 1915, 887, “National Negro Health Week,” reel 713, BTW, TA. There are many examples of this advice for immigrants. Regarding hand washing see for example Francis H. McLean, “The Trend of Charity Organization and Endorsement,” The Survey, 22(21) August 21, 1909 707-713, 712.

200 “Health Week – March 21-27,” Extension Department of Tuskegee Institute, March 21- 27, 1915, 889, “National Negro Health Week,” reel 713, BTW, TA.

201 “Health Week – March 21-27,” Extension Department of Tuskegee Institute, March 21- 27, 1915, 889, “National Negro Health Week,” reel 713, BTW, TA. Alcohol was a significant target of charity work in immigrant populations. See for example Luella F. McWhurter, “Alcoholism,” The Survey 30(24) September 13, 1913: 724; “‘Watch Your Sneeze’ or Spread Disease,” The Survey 35(14) January 1, 1916: 371.

202 “Dallas Local,” Dallas Express, March 27, 1915, “THC, 1915,” 238, TA; “Health Week Begins Monday,” Savannah Tribune, March 20, 1915, “THC, 1915,” 238, TA; “State Wide Health Week,” The Journal and Guide, February 26, 1915, “THC, 1915,” 232-233, TA; “Health Day at Princevill Graded School,” The Journal and Guide, April 13, 1915, “THC, 1915,” 225, TA.. 175

They stressed that blacks had improved, and would continue to improve, their status.

Such talks tended to focus on the health improvements African Americans made.203

As a campaign largely dependent on grassroots support, each city and town organized its Week differently. Savannah held four meetings featuring lectures during the Week and began on Monday, March 22 instead of Sunday, March 21. The local medical society led one session on oral hygiene, baby care, and TB. The Urban League’s female members led the third meeting on women’s health concerns. The fourth session acted as a culmination of the Week, and featured speeches from physicians, religious leaders, and private citizens, such as real estate agents and insurance salesmen. They all explained how health issues affected their particular fields, emphasizing the community-wide impact of health.204

Virginia’s Negro Organization Society organized a broader campaign that had a greater emphasis on activities during its six day observance. In addition to the sermon on

Sunday, the Society collected money throughout the state for a sanitarium to treat black consumptives. Tuesday, the Week focused on teaching health to black school children.

Partnering with the Society, the State School Board and the Board of Education published a special program on health for all the black schools in the state. Wednesday through

Friday were clean up days for the house and yard.205

203 See for example “Negro Health Week Program Attracted Wide Attention,” Savannah Tribune, March 29, 1915, “THC, 1915,” 218, TA.

204 “Negro Health Week Program Attracted Wide Attention,” Savannah Tribune, March 29, 1915, “THC, 1915,” 218, TA.

205 Robert Moton to Booker T. Washington, March 22, 1915, 552, “Moton, Robert Russo 1915,” reel 61, BTW, TA; “State-wide Clean-up,” The Journal and Guide, February 27, 1915, “THC, 1915,” 238, TA. 176

Participation in Alabama’s rural Marion and Perry County looked similar. Here,

NHW leadership consisted almost exclusively of local reverends, the most respected leaders in black communities. Unsurprisingly, the County’s Week began with the standard focus on sermons and health on Sunday. It then devoted the next five days to cleaning up and whitewashing before a final Health Conference on Friday, March 26, which included talks by a local physician and the local Superintendent of Education.206

At Tuskegee, the program connected each day of the Week with a specific cleaning effort. On Sunday, participants went to church to “Start off with a clean heart.” Monday involved airing out the house and cleaning the kitchen, while Tuesday’s target was the toilet. Wednesday was for putting screens in windows and draining stagnant water, and

Thursday focused on cleaning wells. Friday was for cleaning the entire house and whitewashing the outside. On Saturday, the Week asked all participants to take a bath.

The Week encompassed Washington’s emphasis on low cost ways to improve health.

Tuskegee’s week also called for all members of the household to have and use a toothbrush, a push for oral hygiene that, as discussed earlier, was a pet project of

Washington’s.207

Major cities also participated. In Atlanta, organizers scheduled two days of events.

The first was on the Sunday the Week started, and began with ministers speaking to their

206 “Program of health Week,” March 21-27, 1915, 896, “National Negro Health Week,” reel 713, BTW, TA.

207 “Health Week – March 21-27,” Extension Department of Tuskegee Institute, March 21- 27, 1915, 889, “National Negro Health Week,” reel 713, BTW, TA; “Negro Health Week Program Attracted Wide Attention,” Savannah Tribune, March 29, 1915, “THC, 1915,” 218, TA; “Health Week Comes to Brilliant Close at Dexter Ave. Baptist Church,” The Colored Alabama, April 3, 1915, “THC, 1915,” 223, TA; “Health Week Program at D Exeter Ave. Baptist Church,” The Colored Alabama, March 27, 1915, “THC, 1915,” 249, TA; “Packed House Hear Brilliant Artists Sunday,” Chicago Defender, March 27, 1915, 5. 177 church congregations about health concerns. After church, organizers led a variety of health talks sponsored in part by the YMCA and members of the Anti-Tuberculosis

League. On Tuesday, Atlanta’s black school children went to local churches to get health pamphlets and hear talks on health by physicians and health officials.208 New York City’s week focused on health talks as well, but it also included milk stations, one-on-one sessions on infant care, and the distribution of health literature.209

Baltimore’s Health Week received the most publicity of any city because Washington attended.210 The three-day symposium at Bethel AME Church was the main focus of

Baltimore’s Week, which included a health exhibit and films. In addition to Washington, the conference had a number of other speakers. Secretary of State Robert P. Graham spoke and announced Governor Phillips Goldsborough’s support for a black TB sanitarium. Although the Governor did not attend himself, sending the Secretary of State indicated the amount of attention the Week generated in the state. Indeed, it was enough to convince the Governor to make a specific health initiative to aid African Americans.

In addition to a variety of other physicians, health officials, and religious leaders, both white and black, who spoke during the Week, there were a few other notable presenters.

Eleanor Jones of the Instructive Visiting Nurses’ Association shared the stage with the male speakers to discuss simple ways to fight tuberculosis. W.E.B. Du Bois, who had

208 “Program Health Week,” Atlanta Independent, March 20, 1915, “THC, 1915,” 237, TA; “Program Health Week,” Atlanta Independent, March 20, 1915, “THC, 1915,” 237, TA.

209 “It’s Health Week for the Negroes,” Morning Star, March 22, 1915, “THC, 1915,” 225, TA; “Mr. E. K. Jones Will Visit Chicago,” The Chicago Defender, October 30, 1915, 1.

210 “Will Hold a Health Exhibit,” Baltimore Afro-American, February 20, 1915, 7; “Baltimoreans Preparing for Health Week,” Philadelphia Tribune, March 6, 1915, 1; R. W. Thompson, “Wizard of Tuskegee Talks on Health,” The Chicago Defender, April 3, 1915, 4. 178 originally pitched the idea of community organization to improve health, spoke as well.

While he and Washington appeared on different days, Du Bois’ attendance illustrated

Washington’s early argument of the unity that the topic of health could generate in the

African American community.211

Washington’s speech kicked off the conference. His talk was similar to the press releases sent out in preparation for the Week, hitting many of the points that the Week’s

Bulletin and organizers highlighted. He began by recounting the annual numbers of black sickness and death and the economic affect such ill health had on the country. He then moved on to ask for interracial unity to improve black health and emphasized the ways in which black health affected whites. Lastly, he connected health with racial segregation,

“Wherever the Negro is segregated, in most cases it means that he will have poor streets, poor lighting, poor sidewalks, poor sewerage, poor sanitary conditions generally…”212

According to Washington, segregation made things worse for both races because it prevented blacks from improving their conditions, and black ill health affected white health, both financially and because diseases disregarded the color line. His words implored whites to intercede on behalf of blacks, and implied blacks could not change their situation without white help.

Such a tone contrasted sharply with Du Bois’ speech on the final day of the conference. As opposed to Washington, who noted the problems segregation caused for

African Americans, Du Bois directly confronted the issue, asking listeners to “Fight

211 “Thousands Attend First Public Health Conference,” Baltimore Afro-American, March 27, 1915, 1.

212 “Thousands Attend First Public Health Conference,” Baltimore Afro-American, March 27, 1915, 1. 179 segregation with our last cent and last ounce of energy.”213 As with his Health and

Physique of the Negro American, Du Bois attacked the idea that African Americans were inherently unhealthy. He also noted that statisticians calculated black death rates using the unhealthiest in the black population, which made the statistics look worse than they were.214 While the two agreed on the importance of health and the problems that segregation posed, they differed on how African Americans should work to improve their health. As with other issues facing African Americans, Washington offered a much more gradual approach unlikely to change the place of African Americans in America, whereas

Du Bois demanded a more direct and immediate attack on the structures in society that forced African Americans into ill health.

NHW in 1915 – Assessment and Future

The success of the Week is hard to measure. The bookends to Baltimore’s Week that

Washington and Du Bois provided generated a great deal of attention. Some 6,000 people came to hear Washington speak at a Church that could only hold 3,000, and the rest of the Week’s activities were also well-attended.215 Instead of counting people, New York

City leaders counted the 111,000 pieces of health material distributed and the 18,000

213 “Thousands Attend First Public Health Conference,” Baltimore Afro-American, March 27, 1915, 1.

214 “Thousands Attend First Public Health Conference,” Baltimore Afro-American, March 27, 1915, 1.

215 “Thousands Attend First Public Health Conference,” Baltimore Afro-American, March 27, 1915, 1; R. W. Thompson, “Wizard of Tuskegee Talks on Health,” The Chicago Defender, April 3, 1915, 4. 180 black homes visited as evidence of the Week’s accomplishments.216 Similarly, but on a much smaller scale, the leaders of Tuskegee’s local Week celebrated the 15 newly whitewashed houses as part of the Week’s feat.217

In terms of its participants, the Week had wide appeal. Articles supporting the Week appeared across Christian denominations, in both the African Methodist Episcopal Zion

Church’s The Star of Zion, and the African Methodist Episcopal Church’s The Christian

Recorder. White denominations, such as the Baptist Home Mission Society and the

Freedmen’s Board of the Presbyterian Church also participated.218 Indeed, according to

The Indianapolis Freeman, “Never before has there been such a widespread co-operation of the races in a movement for the general good.”219 Monroe Work noted the support the

Week received from “the very cordial and active assistance given by State and City

Boards of Health, by State Departments of Education, by white women’s clubs and other agencies…”220 More specifically, in The Freeman’s summary of Health Week, it reported that “The health department of every Southern State, of many of the cities in the South, large and small…” supported the Week, along with the State Departments of Education

216 “Mr. E. K. Jones Will Visit Chicago,” The Chicago Defender, October 30, 1915, 1.

217 “Health Clean Up Campaign.” March 30, 1915, 936, “National Negro Health Week,” reel 713, BTW, TA.

218 “National Negro Health Week,” The Freeman, June 12, 1915, “THC, 1915,” 249, TA; “Observe Health Week,” The Christian Recorder, March 15, 1915, “THC, 1915,” 220, TA; “R. R. Wright, Jr., “Economic Loss Due to Sickness,” Christian Recorder, April 1, 1915, “THC, 1915,” 244, TA.

219 “National Negro Health Week,” The Freeman, June 12, 1915, “THC, 1915,” 249, TA.

220 Monroe Work, “The South and Negro Health,” 1915, 8, folder 1, box 5, Monroe Nathan Work (MNW), TA; Monroe Work to Emmett Scott, March 29, 1915, 62, “January-June 1915,” “Records and Research, Work, Monroe Nathan,” reel 548, BTW, TA; E. R. Park to Booker T. Washington, March 25, 1915, 63, “January-June 1915,” “Records and Research, Work, Monroe Nathan,” reel 548, BTW, TA. 181 in Arkansas, Tennessee, and North Carolina.221 The paper also recognized the support of the white newspapers that had implored readers to aid blacks in the Week’s activities and noted the Week had participants throughout the country, and not just the Deep South. The paper concluded that African Americans from all backgrounds, classes, religious denominations, and types of areas, rural and urban, participated in the Week.222

However, The Freeman’s portrayal of Negro Health Week’s “National” influence illustrated Washington’s interest in publicity and influence with the newspaper’s editors rather than the reality of the campaign’s reach.223 There was little participation in the

North, due in part to the small numbers of African Americans who resided there. Another important element was that much of the previous efforts Work, Moton, and others made to improve black health occurred in the South. It was easier to work with those already experienced in organizing to promote black health, and the South was where most black organizations had the most influence. Indeed the Week’s goals included items particular to rural African Americans, such as maintaining wells, cleaning yards, and repairing stables and barns. African Americans in the urban North often lived in tenements without access to such things. While Washington and others used the term “National Negro

Health Week,” the “National” part was a misnomer in 1915 and remained so until

1921.224

221 “National Negro Health Week,” The Freeman, June 12, 1915, “THC, 1915,” 249, TA.

222 “National Negro Health Week,” The Freeman, June 12, 1915, “THC, 1915,” 249, TA.

223 Harlan, Booker T. Washington: Volume 2, 98; Robert M. Taylor, Jr., “Indianapolis Freeman,” in The Encyclopedia of Indianapolis, ed. David J. Bodenhamer and Robert G. Barrows (Bloomington, IN: Indiana University Press, 1994): 781.

182

Regardless, enthusiasm for the topic of health and the Week’s health proposals did not abate on March 27. As a direct result of the Week in New York City, the Urban

League joined with the City’s Department of Health to create a monthly health bulletin.225 In Savannah, the local Grand Master of the Masonic Lodge urged Masons to

“have 365 health days in each year,” presaging future attempts to expand the Week beyond seven days.226 Some cities continued to organize Health Weeks after the appointed time of March 21-27.227 Even white organizations took a greater interest in

African American health after the Week. The Southern Sociological Congress used the slogan “The Health Fight Is Everybody’s Fight!” as the theme of its 1915 meeting. In addition, it held a special session on the issues of race and health and invited Monroe

Work to speak on black health concerns.228 As a result of the Congress, Work reported that “the white church of the South through the several denominations and the white women of the South through their various organizations have committed themselves to carry on a general campaign for health improvement,” that included aiding black

224 Chapter 4 will discuss the transition that made Negro Health Week an actual, national campaign.

225 “Mr. E. K. Jones Will Visit Chicago,” The Chicago Defender, October 30, 1915, 1.

226 “Health Proclamation,” Savannah Tribune, April 3, 1915, “THC, 1915,” 218-219, TA.

227 For example, Norfolk. See “Clean-up Days Next Week,” The Journal and Guide, April 10, 1915, “THC, 1915,” 237, TA.

228 “Preliminary Program, Southern Sociological Congress,” Southern Sociological Congress, unknown date of publication, 879-882, “National Negro Health Week,” reel 713, BTW, TA; Monroe Work to Booker T. Washington, May 24, 1915, 249-251, “1915,” “Records and Research, Work, Monroe Nathan,” reel 548, BTW, TA. 183 health.229 Nationally, the American Public Health Association approached Washington about partnering with the Week the following year.230

In addition to creating more interest in health, the Week maintained support for the previous clean-up weeks organized in the South. Branches of the NACW often led such campaigns and they continued to do so. They successfully lobbied the governors of South

Carolina, Mississippi, and Alabama to declare state-wide clean-up weeks to follow

Health Week and organized local observances as well.231 Just as the Week capitalized on efforts in the South to organize clean-up activities, so to the clean-up organizers capitalized on the mobilization that Health Week initiated.

The Week’s organizers planned to continue and improve the Week the following year. As Emmett Scott’s 1915 NNBL report proclaimed, “No agency at work under the general direction of the National Business League has accomplished so much good in so short a time as this National Negro Health Week Movement.”232 Leaders eagerly collected the names and addresses of health officials and organizations that worked on the Week to improve coordination in 1916.233 They also considered moving the Week’s

229 Monroe Work to Booker T. Washington, May 24, 1915, 250, “1915,” “Records and Research, Work, Monroe Nathan,” reel 548, BTW, TA.

230 Beardsley, A History of Neglect, 103.

231 “Clean-up Week for South Carolina, Mississippi and Alabama,” The Progressive Farmer, April 3, 1915, “THC, 1915,” 234-235, TA; “Clean-up Week to Begin in Alabama on Fifth of April,” Montgomery Advertiser, March 13, 1915, “THC, 1915,” 238, TA; “All Forces Unite for Big ‘Clean-Up Week’ in Atlanta,” The Atlanta Constitution, March 28, 1915, “THC, 1915,” 232, TA; “Clean-up Week,” Montgomery Advertiser, March 18, 1915, “THC, 1915,” 227, TA.

232 William H. Davis, National Negro Business League Annual Report of the Sixteenth Session and the Fifteenth Anniversary Convention (Washington, D.C., 1915), 276, TA. One can see Washington’s interest in publicity in this statement with Scott declaring the campaign now not only “Naitonal” but also a “Movement.”

184 start date. Organizers in the North thought the late March date limited participation since the region’s cold temperatures made it difficult to motivate people to paint their homes and fences, or come out to lectures.234 Although the Philadelphia Tribune printed NHW press releases, it did not report any activity within the city. The Chicago Defender published stories about just a few small NHW meetings in the Windy City.235 Therefore,

Washington considered pushing the date back to April or even May.236

The costs of the Week also required consideration. The Tuskegee Institute spent

$7,500 on the Bulletin and more than $2,000 on gallery proofs for newspapers and various organizations to promote the Week. In total, the first Week cost $16,213.237 This number paled in comparison to other contemporary health campaigns the government and diverse white philanthropists funded. Between 1913 and 1933, the Sanitary Commission spent an average of $189,152.25 each year and the NTA spent more than $100,000 between 1914 and 1917.238 Although Tuskegee, the NNBL, and donations covered the

233 Emmett Scott to Monroe Work, March 27, 1915, 61, “January-June 1915,” “Records and Research, Work, Monroe Nathan,” reel 548, BTW, TA; Monroe Work to Emmett Scott, March 29, 1915, 62, “January-June 1915,” “Records and Research, Work, Monroe Nathan,” reel 548, BTW, TA; E. R. Park to Booker T. Washington, March 25, 1915, 63, “January-June 1915,” “Records and Research, Work, Monroe Nathan,” reel 548, BTW, TA; Robert Moton to Emmett Scott, July 10, 1915, 585, “.“Moton, Robert Russo 1915,” reel 61, BTW, TA.

234 Booker T. Washington to Robert Moton, March 4, 1915, 539, “Moton, Robert Russo 1915,” reel 61, BTW, TA; Booker T. Washington to Robert Moton, October 12, 1915, 602, “Moton, Robert Russo 1915,” reel 61, BTW, TA; Robert Moton to Booker T. Washington, October 18, 1915, 603, “Moton, Robert Russo 1915,” reel 61, BTW, TA.

235 “Packed House Hear Brilliant Artists Sunday,” Chicago Defender, March 27, 1915, 5.

236 Booker T. Washington to Robert Moton, March 4, 1915, 539, “Moton, Robert Russo 1915,” reel 61, BTW, TA.

237 Memo “National Negro Health Day” to Tuskegee Normal and Industrial Institute, March 1, 1915, 917, “National Negro Health Week,” reel 713, BTW, TA.

185

Week’s costs in 1915, the limitations of the $500 grant from the Phelps-Stokes Fund were readily apparent.239 Thus, to cover the costs of pamphlet printing and other elements, NHW leaders sought to partner with philanthropic organizations in the future.240

Even with all the enthusiastic preparation, the Week did not take place in 1916.

Ironically, while Washington promoted ways that all African Americans could improve their health, he ignored his own. He concealed his high blood pressure and kidney problems from those closest to him. With appropriate care these issues were treatable, but instead heart failure felled the Wizard of Tuskegee on November 14, 1915.241

Washington’s death made organizing the Week next to impossible. In addition to losing its leader and the face of the campaign, the Tuskegee Institute was where the

Week’s leaders met, and it was responsible for much of its funding. Washington’s death meant that the school needed a new principal. The Week’s other financial partner was the

National Negro Business League, where Washington was president. Thus, Washington’s death left a gaping hole in the Week’s organizational structure.

238 George B. Tindall, The Emergency of the New South, 1913-1945 (Baton Rouge, LA: Louisiana State University Press, 1967), 276; Richard Harrison Shyrock, National Tuberculosis Association, 1904-1954: A Study of the Voluntary Health Movement In the United States, Reprinted Edition (New York, NY: Arno Press, 1977), 145.

239 Anson Phelps Stokes to Booker T. Washington, November 24, 1914, in The Booker T. Washington Papers, volume 13: 182-183; Monroe N. Work, Negro Year Book and Annual Encyclopedia of the Negro, 1914-1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 332.

240 Monroe Work to Albon Holsey, June 30, 1915, 290, “Administration – Holsey, Albon L., 1915,” reel 538, BTW, TA. The Russell Sage Foundation was the target of this correspondence.

241 Denton, Booker T. Washington and the Adult Education Movement, 124-125. 186

The man chosen to succeed Washington at Tuskegee and, later, at the NNBL, was

Robert Moton. While there were many reasons for this decision, the most obvious was that Moton and Washington shared many traits. Both were born in Virginia, attended

Hampton Institute, and counted its founder, General Samuel Armstrong, as a mentor.

More importantly, Moton subscribed to Washington’s accomodationist approach to race relations and believed in recruiting white philanthropists to aid blacks in uplifting the race. There was also a mutual admiration between the two. Washington had deemed

Moton’s health work with the Negro Organization Society of Virginia so useful that he expanded it to include other southern cities such as Baltimore, Atlanta, and others with large black populations. In describing the Society under Moton’s leadership, Washington exclaimed, “The Negro Organization Society is so unique and at the same time so practical in its objects and results that it commands the respect, confidence, and support of all the best people of both races throughout Virginia.”242

For his part, Moton looked up to the Tuskegee principal. After Washington spoke at the Society’s 1913 annual meeting, Moton wrote to Washington, “As I said Sunday night before last, ‘I would rather be Booker Washington than President Wilson’ and I got the applause of Northerners and Southerners.”243 Washington’s esteem for Moton and the values the two shared made the transition to a new principal, Tuskegee’s second ever, as smooth as possible given the loss of such a highly respected and powerful individual.

242 Booker T. Washington, “What Co-Operation Can Accomplish,” November 12, 1914, 1, folder 10, box 118A, BTW, TA.

243 Robert Moton to Booker T. Washington, November 10, 1913, 431, “1913 June- December,” “Moton, Robert Russa,” reel 61, BTW, TA. 187

Moton’s Negro Health Week, 1917-1919

Washington’s death raised the prospect of the elimination of a number of African

American organizations and programs. As an example, Moton explained that “Hitherto the [National Negro Business] League has been largely an inspirational organization carried forward by the wonderful personality of its founder and president, Dr.

Washington…”244 Although there were other influential conservative African Americans, none had the charisma and public personality of Washington. Some worried that without

Washington, organizations like the Business League – which he founded - would fall apart. However, Washington’s death also presented an opportunity to make these organizations stronger by building them around specific goals and clear objectives instead of being dominated by Washington.

As Moton and J.C. Napier, who followed Washington as president of the Business

League, attempted to navigate a post-Washington world, they used Washington’s recent work to galvanize the black health movement. Thus, health was one of the “Features of the Session,” at the NNBL’s 1916 annual convention. The topic’s popularity left Moton and others with the impression that Negro Health Week could make a comeback, particularly if leaders emphasized Washington’s work in the promotion of the Week.245

Although the connection to Washington would provide greater publicity for the Week,

244 Robert Moton to William C. Graves, October 5, 1916, folder 79A, box 11, Robert Moton General Correspondence (RMGC), TA.

245 Davis, Report of the Seventeenth Annual Session, 202, TA; National Negro Business League: Seventeenth Annual Session, August 16-18, 1916, 5-6, folder 1, box 21, National Negro Business League (NNBL), TA. 188

Washington’s personal absence would allow the Week’s facilitators to establish a movement independent of a single person.246

Given this reasoning and Moton’s interest in the health campaign he helped inspire, the new principal started forming plans for another Health Week in late 1916. He laid the groundwork for the Week in a similar manner as Washington. When speaking in

Montgomery, Alabama, Moton discussed the specific number and economic impact of sick blacks in the city.247 He also used the Week to reach out to Washington’s past benefactors to both smooth the principal transition and maintain support. For example, he had Emmett Scott consult with William C. Graves, secretary to the philanthropist, and

Washington supporter, Julius Rosenwald, about advertising strategies for the Week.248

The 1917 campaign tried to pick up where the 1915 one left off. Work arranged with

Scott to send out 1,000 letters and a total of 15,000 pieces of correspondence to various groups promoting the Week. Many black organizations received these letters, including leaders of black churches, black hospitals, and some medical associations. However, 40% of those who received letters, the biggest single group, were of the educated, non-medical ranks.249 Such choice in publicizing the Week reflected the NHW leaders’ lack of

246 Robert Moton to William C. Graves, October 5, 1916, folder 79A, box 11, RMGC, TA.

247 Monroe Work to Emmett Scott, October 19, 1916, “Monroe Work” folder, box 5, Robert Moton Local Correspondence (RMLC), TA.

248 William C. Graves to Emmett Scott, November 11, 1916, folder 79, box 11, RMGC, TA.

249 Monroe Work to Emmett Scott, January 4, 1917, “Monroe Work” folder, box 9, RMLC, TA; The Tuskegee Institute Bulletin: Annual Report Edition, 1916-1917 (Tuskegee, AL: Tuskegee Normal & Industrial Institute, 1917), 23. 189 medical expertise and their effort to reach a broad audience with basic, non-technical health information.

The apathy of one of the nation’s leading black doctors may also have affected the advertising strategy Moton, Scott, and Work, used. By 1917, Dr. John Kenney was a well-regarded physician. He had helped create and edit the JNMA and was the director of the John A. Andrews Memorial Hospital at Tuskegee. His founding of the John A.

Andrew annual clinic in 1912 helped establish Tuskegee as a center for health. Year- after-year it brought black and white physicians together to examine rural African

Americans.250 Yet Kenney ostensibly declined to take a leading role in NHW. When

Moton asked him to organize Tuskegee’s participation for the Week, Kenney responded

“I shall be glad to participate…in whatever way seems satisfactory.”251 Kenney’s lack of initiative towards NHW stands out, especially compared to his enterprising medical work. While agreeing to participate, he placed responsibility for Tuskegee’s Week back at the feet of non-doctors Scott and Moton. While it is unclear exactly why Kenney decided not to take a more active role in the Week, his passing on the opportunity left

NHW organizers without a medical professional’s voice in the Week’s leadership.

In addition to mailing fliers to educators, Work also asked Scott to send announcements to “boards of white denominations among Negroes.” The YMCA and

YWCA, which had some local arms participate in the 1915 Week, received announcements, as did whites in charge of rural schools. Again, while the emphasis was

250 “In Memoriam,” National Negro Health News 18(2) 1950: 16; John A. Kenney, “A Plea for Interracial Cooperation,” Journal of the National Medical Association (JNMA) 37(4) 1945: 121- 124, 123-124.

251 John Kenney to Emmett Scott, March 5, 1917, “John Kenney” folder, box 7, RMLC, TA. 190 on black involvement, the Week’s leaders continued Washington’s work in using the topic of health to cross racial boundaries.252

One significant change from the 1915 Week was to award prizes for participation.

Given the focus on clean up, Allen W. Clark, chairman of the Clean Up and Paint Up

Bureau, donated three silver cups for the best Health Weeks each year.253 While the organizers did not aim to incentivize participation, they saw the awards’ utility and the impact such competitions had on white health campaigns.254 To earn a prize, communities had to submit a detailed report on their Week, including the activities organized and the number of participants. This information allowed the Week’s leaders to better track participation and identify the best activities so that they could tailor future programs. It also gave people another reason to participate, something which was less necessary when Washington’s presence was behind the Week. Lastly, the prizes provided an opportunity for more people to participate in the Week’s leadership since NHW now needed judges to decide on the awards.

The Week’s judges came from both the North and South and had a variety of backgrounds. Three were doctors, including NMA president Dr. D. W. Byrd. Two of the most prominent national black women leaders also served as judges: Nannie H.

Burroughs, Corresponding Secretary to the Woman’s Convention of the National Baptist

Convention and principal of the National Training School for Women and Girls; and

252 Monroe Work to Emmett Scott, January 4, 1917, “Monroe Work” folder, box 9, RMLC, TA.

253 “About National Health Week,” Philadelphia Tribune, March 10, 1917, 1.

254 See for example “Civil Competition in Child Welfare,” The Survey 35(9) November 27, 1915, 203. 191

Mary B. Talbert, president of the National Association of Colored Women.255 That two of the 12 judges were women not only illustrated the important role females played in organizing the local Weeks, but also recognized the power of these organizations that women had built. In particular, the groups Burroughs and Talbert led had powerful bases in Alabama. Having judges based in both the South and North also encouraged greater participation and dissemination of the Week throughout the nation, though northern participation remained scant.

Other elements of the Week were similar to those of 1915 with some slight adjustments. First, organizers printed “The Conservation of Negro Health” pamphlet, but put Washington’s face on the cover to emphasize the Week’s connection to the deceased leader and garner greater attention. Second, Moton encouraged local leaders to duplicate and adjust the pamphlet to make it more accessible and tailor it to their community’s needs.256 Third, responding to northern concerns, the Week’s leaders moved the start of the Week to April 22. Fourth, the Week’s leaders proposed a theme for each day of the

Week, starting with a Sermon Day on the Sunday the Week began. While the leaders retained most of the specific 1915 goals, they assigned an activity to each day of the

Week. For the rest of the decade, the Week dedicated a day each for cleaning the house, cleaning the yard, and cleaning up vacant lots, as in the past. However, due to the participation of the Clean Up and Paint Up Bureau, it devoted a day to painting and

255 “Suggested Committee to award cups in connection with Negro Health Week,” unsigned and undated, “Health Week” folder, box 7, RMLC, TA; “First Prize For Clean-up Week Goes to Atlanta, GA,” Southwestern Christian Advocate, July 19, 1917, “THC, 1917,” 372, TA. For more on Burroughs and Talbert, see Bettye Collier-Thomas, Jesus, Jobs, and Justice: African American Women and religion (New York, NY: Knopf, 2010). For Burroughs up to the late 1910s, see especially 127-134. For Talbert, see especially 306-309.

256 Davis, Report of the Eighteenth and Nineteenth Annual Sessions, 61, TA. 192 whitewashing. The other days focused on fire-prevention and fighting not only flies, but also mosquitoes and rats.257 Thus, NHW leaders created a more unified campaign that had communities conducting the same practices and activities on the same days.

The appeals to participate were also similar through 1920. Religious and economic petitions remained popular.258 Newspapers also continued to emphasize racial uplift. The

Urban League asserted that two of the three causes of black mortality involved

“ignorance or disregard of the demands of right living, and the keeping of unsanitary homes.”259 Healthy living would increase the number of African Americans, giving them more political and economic power through sheer numbers.

As others argued in 1915, the Chicago Defender portrayed the Week was an opportunity to fight segregation. The Defender explained that whites justified segregation by asserting that blacks could not “improve nor keep up the repairs on their own property and that they keep the back yards full of old cans, piles of ashes and beer bottles…and other rubbish.”260 Baltimore Mayor James Preston illustrated this principal, describing health conditions in black neighborhoods as constituting “a menace to the health of the

257 “Negro Health Week to be Observed, April 22-28,” Houston Observer, April 21, 1917, “THC, 1917,” 361, TA; “National Negro Health Week,” Southwestern Christian Advocate, April 11, 1918, “THC, 1918,” 903, TA; “National Negro Health Week,” The Daily Herald, undated, “THC, 1919,” 735, TA. In 1920, organizers included combating flies and pests under the “cleaning the yard” day and dedicated a “Health day in the schools” see “Health Week to be Observed: A Week’s Program,” Philadelphia Tribune, March 20, 1920, 9.

258 “National Health Week,” Southwestern Christian Advocate, March 29, 1917, “THC, 1917,” 360, TA; “National Health Week,” The Freeman, April 7, 1917, “THC, 1917,” 366, TA.

259 “Urban League Has Big Health Welfare Plans,” Amsterdam news, April 11, 11917, “THC, 1917,” 365, TA.

260 Dr. A. Wilberforce Williams, “Talks on: Preventive Measures, First Aid Remedies Hygienics and Sanitation,” Chicago Defender, April 21, 1917, “THC, 1917,” 369, TA. 193 white population.” He advocated segregation as the only way to protect whites.261 Even when C. P. Wertenbaker had tried to create an organization of black TB societies, he noted, “If it is demonstrated to the municipal authorities that the negro is as careful of his section of the city as the whites, his wants will receive consideration.”262 For urban

African Americans, painting and cleaning represented not only a significant action to improve health, but also a political action to refute white racism and segregation.

Participation also changed little. Churches helped to organize the Week and hosted lectures by both physicians and clergy.263 Speakers discussed how people could improve health within their own homes, such as making sure windows shut tight to avoid flies and mosquitoes and bathing regularly. “Avoiding the technical medical phraseology,” doctors connected common problems such as indigestion, head pain, and irregular heartbeat to improperly cooked food and other easily correctable practices.264 Interracial efforts also continued to be a point of emphasis. In Atlanta, white newspapers supported the Week

261 Antero Pietila, Not in My Neighborhood: How Bigotry Shaped a Great American City (Chicago, IL: Ivan R. Dee, 2010), 52; Roberts, Jr., Infectious Fear, 14.

262 Wertenbaker, “A Working Plan for Colored Antituberculosis Leagues,” 10-11, Box 771 36434, Pamphlet Collection, NYAM.

263 “National Negro Health week Observed,” Washington Evening Star, undated, “THC, 1917,” 368, TA; “Eleven Million Race Men, Women and Children Enlist in Six Day Battle Against Disease-Improved health Conditions The Race’s Best Step Toward Preparedness – Thirty Thousand to Respond to Call in Dallas,” Dallas Express, April 21, 1917, “THC, 1917,” 367, TA; “League Health Week to End With 4 Meetings,” New York Amsterdam News, April 25, 1917, “THC, 1917,” 360, TA; “Negro Health Week Brings Good Results,” Savannah Tribune, April 27, 1918, “THC, 1918,” 901, TA; “This Week’s Health Week,” The Amsterdam News, April 24, 1918, “THC, 1918,” 902, TA; “Wilmington,” Baltimore Afro-American, February 9, 1918, 6; “Greater New York Observes National Negro Health Week,” New York Age, May 4, 1918, “THC, 1918,” 905, TA; “Health Week Terminates,” Chicago Defender, May 3, 1919, 4; “Urban League Ends Health Week,” Chicago Defender, May 10, 1919, 4.

264 “Teachers Working for Health Week Campaign,” Savannah Tribune, April 21,1917, “THC, 1917,” 370, TA. 194 and white organizations donated lime to aid whitewashing and sanitation work. In

Savannah, the Urban League worked with white groups to create health pamphlets.265

One significant difference with 1915 concerned the public participation of insurance companies. During 1915, while North Carolina Mutual and Provident Association sent out 50,000 leaflets on sanitation, most insurance companies gave limited, if any, support.266 In 1917, seven companies paid for and distributed 50,000 health leaflets in

Atlanta alone, and the Week’s in Savannah, Nashville, and New York all had financial support from African American insurance companies.267 In Nashville, the four African

American colleges in the area organized to send students to distribute health pamphlets that the city’s board of health had created with a local insurance company. Nashville’s organizers calculated they had distributed more than 24,000 health leaflets along with at least 2,000 fly swatters.268

265 Davis, Report of the Eighteenth and Nineteenth Annual Sessions, 64-66, TA; “Clean Up Week Is Being Widely Observed in Atlanta,” Atlanta Independent, April 28, 1917, “THC, 1917,” 363, TA; “Plans are Completed for National Health Week in City of Atlanta,” Atlanta Independent, April 21, 1917, “THC, 1917,” 364, TA; “Negro Health Week to be Observed in this City Beginning Sunday Night,” Savannah Tribune, April 21, 1917, “THC, 1917,” 362, TA; “Free Medical and Dental Clinic to be Held,” Savannah Tribune, April 21, 1917, “THC, 1917,” 365, TA; “Health Week Is To Be Observed April 22-28,” Savannah Tribune, April 7, 1917, “THC, 1917,” 369-370, TA; “Teachers Working for Health Week Campaign,” Savannah Tribune, April 21,1917, “THC, 1917,” 370, TA.

266 Davis, Annual Report of the Sixteenth Session and the Fifteenth Anniversary Convention, 117, TA.

267 Davis, Report of the Eighteenth and Nineteenth Annual Sessions, 64-65, TA; “League Health Week to End With 4 Meetings,” New York Amsterdam News, April 25, 1917, “THC, 1917,” 360, TA; “Negro Health Week to be Observed in this City Beginning Sunday Night,” Savannah Tribune, April 21, 1917, “THC, 1917,” 362, TA; “Plans are Completed for National Health Week in City of Atlanta,” Atlanta Independent, April 21, 1917, “THC, 1917,” 364, TA; “State Normal News,” Nashville Globe, May 11, 1917, “THC, 1917,” 364, TA; “Negro Health Week Highly Successful,” Tennessean, May 3, 1917, “THC,” 370, TA.

268 “Negro Health Wek Highly Successful,” Tennessean, May 3, 1917, “THC, 1917,” 370, TA. 195

Part of the reason insurance companies increased their participation was due to the emphasis the NNBL placed upon the Week. As discussed earlier, the Week’s leadership thought of NHW as a way to demonstrate the NNBL’s influence and keep blacks organized. Thus, black insurance companies, many of whose administrators were NNBL members, saw it in their interest to participate. Publishing and distributing health literature for public health campaigns also reflected a growing trend within the insurance industry initiated during the NTA’s TB campaign.269 Additionally, organizing the health literature and participating in the Week permitted these companies to take part in identifying what the term “healthy” meant.

Lastly, insurance companies hoped to expand their reach, sell more policies, and expand their profits. More health education would cause clients to file fewer claims.

However many companies went further, partnering with NHW groups to create free clinics, some of which traveled around the city to better serve the poor. These clinics offered black physicians another opportunity to demonstrate their utility to the race, and provided marketing opportunities to the black insurance companies who sponsored them as people looked for ways to protect and ensure, or insure, their health.270

Notwithstanding Dr. Kenney’s reluctance to organize Tuskegee’s Week, post 1915 campaigns made some inroads into the broader community of black physicians.

Nationally, the NMA began to take notice of NHW. The JNMA asked physicians to send

269 Tomes, Gospel of Germs, 186.

270 “Negro Health Week to be Observed in this City Beginning Sunday Night,” Savannah Tribune, April 21, 1917, “THC, 1917,” 362, TA; “Plans are Completed for National Health Week in City of Atlanta,” Atlanta Independent, April 21, 1917, “THC, 1917,” 364, TA; “Free Medical and Dental Clinic to be Held,” Savannah Tribune, April 21, 1917, “THC, 1917,” 365, TA; “Negroes of City Busy Cleaning Up,” Nashville Tennessean, April 26, 1917, “THC, 1917,” 366. 196 in reports about their local Week.271 This widespread physician participation combined with the interest of African Americans to encourage NMA leaders to take a closer look at the Week. NMA president D. W. Byrd even wrote to Emmett Scott, “I wish you would let me know if this health week is to be made a permanent affair. If so, I will have the

Medical Association adopt this, and we will blend our efforts towards making this a great affair throughout the country.”272 Such language illustrated Byrd’s concerns that the

NMA would get left behind of a health movement it could use to gain greater publicity and support for the Association and its members in addition to helping African

Americans improve their health.

Yet without Washington’s personal influence, the Week did not gain the same level of visibility and participation as in 1915. Although leaders made announcements about the Week as early as November 16, 1916, the Chicago Defender, Philadelphia Tribune, and Baltimore Afro-American combined to include only seven articles on the 1917 Week, a far cry from the 37 they ran in 1915.273 While the Week engaged African Americans as far west as Los Angeles, neither Chicago nor Baltimore participated at 1915 levels.274

World War I contributed to some of this decline in participation. As white Americans went to war, industrial jobs opened for blacks in Northern cities. However, restrictions on free time and the rationing of supplies left little opportunity for NHW. Outside of New

York City and Washington, D.C., participation was mostly a Southern affair.

271 “Health Week,” JNMA 9(3) 1917: 142-143.

272 D. W. Byrd to Emmett Scott, July 7, 1917, “Health Week” folder, box 7, RMLC, TA.

273 “Health Week for 1917,” Chicago Defender, November 18, 1916, 2.

274 “California,” Chicago Defender, May 12, 1917, 6. 197

The judges recognized this regionalism, giving prizes to the Week’s in Atlanta,

Salisbury, North Carolina, and New Madrid, Missouri.275 There were a variety of elements that went into winning an NHW award. While Atlanta’s leaders thought the

Week reached 40,000 people, what also likely impressed the award committee were the

25 different local groups that helped organize the Week.276 The ability of a wide range of groups to unite around a single issue reinforced the power of health to bring people together. The demographics of the Week’s participants were perhaps even more important than the number of groups or people involved. As Lugenia Hope, general chairman of the Atlanta committee, explained to the NNBL’s members upon accepting first prize, the Week involved, “beautiful co-operation of white and colored physicians and nurses.”277

The Week’s judges must have found the promotion of not only health, but also racial unity appealing, especially when Hope explained that “there is positive direct evidence that one young life was saved thereby [by the clinic], and many more lives will be prolonged.”278 To get first prize for a Week, organizers had to incorporate many groups

275 J.C. Napier to Emmett Scott, July 2, 1917, “Health Week,” folder, box 7, RMLC, TA.

276 “Urban League Report Shows Much Progress,” Chicago Defender, December 29, 1917, 12; “First Prize For Clean-up Week Goes to Atlanta, GA,” Southwestern Christian Advocate, July 19, 1917, “THC, 1917,” 372, TA; Davis, Report of the Eighteenth and Nineteenth Annual Sessions, 64-65, TA.

277 Davis, Report of the Eighteenth and Nineteenth Annual Sessions, 64, TA. Lugenia Hope was a political activist. She founded the Neighborhood Union in Atlanta, was a prominent member of the NACW, and later joined the NAACP. For more on Lugenia Hope, see Jacqueline Anne Rouse, Lugenia Burns Hope: Black Southern Reformer (Athens, GA: the University of Georgia Press, 1989).

278 Davis, Report of the Eighteenth and Nineteenth Annual Sessions, 67, TA. 198 across racial lines and provide ways for African Americans to uplift themselves, such as

Atlanta’s 16-week free clinic.

To win an award in a less populous area, organizers had to make clear changes to their community. In Salisbury, the Week’s organizers, all women of the Colored Civic

League, arranged for access to free whitewash. By the end of the Week, the mayor exclaimed that all 800 black homes in the city were “in a splendid sanitary condition,”279

Additionally, Salisbury’s NHW organizers worked with the State Board of Health and local insurance agents to provide free health literature. These women and volunteers then distributed over 1,600 leaflets door-to-door on general health and fly and mosquito removal. By the Week’s end, local doctor F. L. Daniels noted that “the number of cases

[of preventative diseases, such as Malarial Typhoid Fever] have been greatly reduced, and the death rate has been correspondingly lowered.”280 As NHW emphasized,

Salisbury’s leaders measured health by houses cleaned, health information disbursed, and pests destroyed, not doctors seen and examinations conducted.

New Madrid earned its award by operating more like Atlanta’s Week and emphasizing NHW’s work in crossing racial boundaries. Although only 600 blacks lived in the small town, organizers convinced the Mayor to issue a proclamation calling for everyone in the town, black and white, to participate simply by removing trash. This choice illustrated the freedom that the Week gave its grassroots organizers in deciding how to participate. New Madrid’s leaders found that their focus on cleaning had ready support from the town’s white citizens. Whites not only participated in the cleanup itself,

279 Davis, Report of the Eighteenth and Nineteenth Annual Sessions, 68-71, 71, TA.

280 Davis, Report of the Eighteenth and Nineteenth Annual Sessions, 71, TA. 199 but they also donated carts and other materials to ease the task. In addition to simply removing trash from the streets and yards, New Madrid’s participants planted crops, mostly vegetables, in the newly cleaned vacant lots.281 Here, New Madrid’s Week combined the patriotic war garden movement that encouraged all citizens to utilize idle land with the Week’s emphasis on health improvement. The gardens not only beautified the town, but they also improved diets and health as a result, especially important as

World War I policies limited food supplies.282 This Week emphasized NHW’s focus on what everyday people could do to improve health on their own.

To increase turnout and generate a more cohesive NHW, leadership, which now included Moton, Work, Scott, and Napier among others, decided they needed to provide a guide that laid out how to create an NHW.283 Many of the people the bulletin targeted did not have the skills of an expert organizer. Such a task might have even overwhelmed some. In its publications promoting the Week, NHW leaders suggested that each local

NHW Clean-Up Committee create six smaller committees to divvy up the Week’s work.

The committee on publicity created advertisements and the committee on meetings arranged for places to hold lectures. The inspection committee assessed the progress the

281 Davis, Report of the Eighteenth and Nineteenth Annual Sessions, 72-74, TA.

282 Rosen, Preventive Medicine in the United States, 1900-1975, 35. Salisbury also emphasized gardening. See Davis, Report of the Eighteenth and Nineteenth Annual Sessions, 70, TA. The idea was also impressed upon charities working with immigrants. See for example “Making Gardens Safe for Vegetables,” The Survey 39(5) November 3, 1917:126-127; Charles Lathrop pack, “The Welding Plot,” The Survey 39(3) October 20, 1917: 63-64.

283 There is no official list of who made final decisions on NNHW policies. However, the records and publications from Tuskegee and elsewhere indicate that the main figures were Moton, Work and Scott, with the NNBL supporting the efforts of this group. Others, such as Allen Clark of the Clean Up and Paint Up Bureau, were mostly on the periphery and had less of a say in decision-making. Having searched through the entire Tuskegee NNHW Collection; there are no records of who made what suggestions for the NNHW bulletin. 200

Week made in improving the areas of greatest need in the community. Alternatively, the committee on flies and mosquitoes and the one on school children both targeted specific concerns. These committees reflected the primary reason for the Week, increasing black life expectancy. Creating health pamphlets and holding activities like health essay contests for school children would create the building blocks to prolong the next generation.284 Such activities were similar to those aimed at poor whites and European immigrants.285

To provide local campaigns with additional resources, NHW leaders suggested creating a finance committee. Moton encouraged breadth in soliciting donations. A large number of small funders was preferable to a few with deep pockets. The more people invested, the more they would discuss the Week and the greater participation and interest.286 These local finance committees also meant that Tuskegee and the League did not require as much money to organize the Week, making it easier to run and giving more autonomy to local organizers.

Unlike the 1915 Week, Moton’s early NHW campaigns did not include a list of specific groups to work with. Although Dr. Byrd had advocated the NMA’s inclusion and

284 “National Negro Health Week,” Southwestern Christian Advocate, April 11, 1918, “THC, 1918,” 903, TA; “National Negro Health Week,” The Daily Herald, undated, “THC, 1919,” 735, TA.

285 See for example “10,000,000 Reasons for Children’s Week,” The Survey 35(24) March 11, 1916:698-699; “Jottings,” The Survey 39(4) October 27, 1917:100. The NTA also held an essay contest.

286 “National Negro Health Week,” Southwestern Christian Advocate, April 11, 1918, “THC, 1918,” 903, TA; “National Negro Health Week,” The Daily Herald, undated, “THC, 1919,” 735, TA. 201 participation in Health Week, the JNMA did not advertise the campaign until 1921.287

Other organizations that aided the Week did so through local chapters rather than as a national effort. Given the apparent effectiveness of local organizers and the expense of creating a network of NHW offices, Moton and Work gave local leaders, those who knew best where to find support, wide latitude to organize the Week.

While the Week remained mostly a Southern affair through 1920, the reports of NHW participation and the publicity the Week generated buoyed the Week’s leaders and encouraged them to continue the campaign. Indeed, NNBL president J. C. Napier described Health Week as a “most important feature of our League work.”288 As noted in the quotation opening this chapter, the NNBL even introduced a special resolution in

1919 recommending that NHW become a year-round campaign.289

In addition to the support of the NNBL and general publicity, another reason to continue the Week involved Booker T. Washington’s legacy. That Washington promoted

NHW encouraged people to participate, and leaders often invoked his name during the

Week. To capitalize on this relationship, in 1920 the Week officially moved the date to a week that included April 5, Washington’s birthday.290 Work and others thought that

287 D. W. Byrd, “Maternity and Infant Mortality,” JNMA 9(4) 1917: 177-180, 180. The JNMA had 1 article on NNHW from 1918-1920 and it appeared after the 1918 NNHW, see “Report of Health Week Observance in Greater New York,” JNMA 10(2) 1918: 89-96, 95-96.

288 J. C. Napier to Robert Moton, February 21, 1918, folder 160, box 24, RMGC, TA.

289 “Negro Health Week,” Nashville Globe, July 19, 1919, “THC, 1920,” 552, TA. Note that this date precedes the actual NNBL meeting held August 13-15, 1919 so either the NNBL released an early resolution knowing it would be approved, or the handwritten date of the article is incorrect.

290 Monroe Work to Robert Moton, July 9, 1919, “Monroe Work,” Folder, box 17, RMLC, TA. The 1919 Week was held from April 5-12 as a trial, but was not made permanent until 1920, see “Annual Health Week to be April 4 to 10,” New York Age, March 6, 1920, “THC, 1920,” 552, 202 holding the Week during this time would reinforce the connections between the Week and Washington, and make commemorations of Washington synonymous with health improvement.

One other reason why Napier, Moton, and others sustained support for the Week was due to the funding it attracted. In addition to Julius Rosenwald and other philanthropists who took a personal interest in the Week, the American Social Hygiene Association held meetings with the Week’s leaders and the Russell Sage Foundation offered to organize lecturers for the Week.291 That the Week could generate such publicity and interest was a boon to Tuskegee as an institution, as well as to the participating organizations, such as the NNBL and the Urban League.

Overall, the first few years of the Week’s existence challenged what Yale

University’s Winslow defined as a “modern public health movement.” According to

Winslow, the two main motives of a public health campaign were “Hygienic instruction, plus the organization of medical service for the detection and the early treatment of incipient disease.”292 The Week’s leaders fulfilled the first motive by formalizing practices so that the average African American could obtain “proper” health. NHW promoted the health benefits of simple and cheap cleanliness strategies, such as whitewashing and cleaning up. It used a combination of national organizations and grassroots organizing to disseminate its message throughout the South. Women were key

TA; “National Health Week to be Observed,” Chicago Defender, March 6, 1920, 2; “A Fitting Tribute to the Founder of the Great Tuskegee Institute,” Philadelphia Tribune, March 6, 1920, 1.

291 Franklin O. Nichols to Albon L. Holsey, December 30, 1920, “Annual” folder, box 18, RMLC, TA; “Chairman, Executive Committee” to Allen Clark, February 27, 1918, “Ca-CL Business League 1918,” Folder, box 72, Albon L. Holsey Collection (ALH), TA.

292 Winslow, The Evolution and Significance of the Modern Public Health Campaign, 58. 203 contributors. The NACW and its affiliates served as organizational networks for local

NHW campaigns and many women served as home inspectors and lecture organizers.

However, the Week’s leaders largely ignored the second motive. Although physicians participated in the Week, often as keynote lecturers, they were not as vital to the Week’s success as they were to other health campaigns. Both the TB movement and the Sanitary

Commission made going to a physician a priority. Although some local Weeks organized free clinics, NHW’s leaders remained focused on what ordinary African Americans could do to improve their health. The dearth of African American physicians, their urban location, and the racism blacks faced from the white medical establishment made promoting medical professional use impractical. Instead of waiting for inaccessible medical professionals to identify individual health problems, the campaign taught blacks what they could immediately do to improve their health. The implementation of these

Victorian practices had the side effect of challenging white racist perceptions of what blacks could and could not learn as well as their overall perception of blacks as being inherently unhealthy.

By the end of the decade, the Week had begun to recover its popularity. It had developed a solid foothold in the South and the Great Migration of African Americans to the North spurred by World War I meant that more people would become familiar with the Week. Additionally, the yellow fever outbreak and health problems with troop requisitions during the war made the general state of American health a growing point of concern and increased interest in NHW. With health established as a national priority, the newly minted U.S. Public Health Service turned its attention to the campaign. The

Service’s support was the catalyst that turned NHW into National Negro Health Week. 204

CHAPTER 4

THE PRICE OF POPULARITY?:

NATIONAL NEGRO HEALTH WEEK AND THE EXPANDING ROLE OF THE

MEDICAL ESTABLISHMENT, 1920-1930

Much of public health service is dependent upon the home and the individual for its effectiveness. The most important requirements of this service are personal and home hygiene, including the simple but essential matters of personal cleanliness, sanitary surroundings, proper feeding, ventilation, the care and control of sickness in the home.”

– Roscoe C. Brown.1

Brown’s description of public health work was similar to the goals and emphases of

NHW. Like NHW, public health work for whites and European immigrants focused on the individual adopting basic hygiene and health practices that were easy to implement.

While African Americans often found themselves segregated in public health campaigns, changes in the 1920s led white Americans to take a greater interest in African American health. In particular, African American migration north, Robert Moton’s influence, and the growing importance of health in the national consciousness led organizations that had been primarily interested in white and immigrant health to take a new interest in black health.

Outside Influences on the Week in 1920

1 Roscoe C. Brown, “The Work of the U.S. Public Health Service with Negroes,” Opportunity 1(2) 1923: 12-13, 12. 205

As NHW organizers ramped up the campaign in the years after Washington’s death, the African American community began to change. The primary reason was the impact of

World War I. The war created an opportunity for African Americans to escape the sharecropping and lynching that were so prevalent in the South, if not the outright discrimination.2 The army primarily drafted young whites and the war prevented

European immigration, leaving African Americans as the largest able-bodied work force.

African Americans could now get jobs in Northern factories where they could earn a decent salary and provide a better education for their children. More than 550,000

African Americans moved from the rural South to the urban North between 1910 and

1920.3 Philadelphia’s black population increased from 84,000 to 134,000, and Chicago’s rose from 44,103 to 109,458, as the percentage of African Americans living in the North increased from 10% to 15%.4 The numbers of African Americans migrating north continued to grow in the 1920’s postwar economic boom. The increase in African

Americans living in the North created new tensions between whites and blacks as blacks

2 For an indepth analysis of discrimination in the North, see Thomas J. Sugrue, Sweet Land of Liberty: The Forgotten Struggle for Civil Rights in the North (New York, NY: Random House Inc., 2008).

3 Reynolds Farley, Growth of the Black Population: A Study in Demographic Trends (Chicago, IL: Markham Publishing Co., 1970), 11, 46-47; Robert Gregg, Sparks from the Anvil of Oppression: Philadelphia’s African Methodists and Southern Migrants, 1890-1940 (Philadelphia, PA: Temple University Press, 1993), 13; “Preliminary Outline for Inter-Racial Organization in Northern Cities,” 3, folder 344, box 52, Robert Moton General Correspondence (RMGC), Tuskegee University Archives, Tuskegee, AL (TA); Kenneth Kusmer, A Ghetto Takes Shape: Black Cleveland, 1870-1930 (Urbana, IL: University of Illinois Press, 1976), 157-159; Tera W. Hunter, To ‘Joy My Freedom: Southern Black Women’s Lives and Labors After the Civil War (Cambridge, MA: Harvard University Press, 1997), 230-235.

4 John F. Bauman, Public Housing, Race, and Renewal: Urban Planning in Philadelphia, 1920-1974 (Philadelphia, PA: Temple University Press, 1987), 12-13; St. Clair Drake and Horace R. Cayton, Black Metropolis: A Study of Negro Life in a Northern City (New York, NY: Harcourt, Brace and Company, 1945), 8-9; U.S Bureau of the Census, Statistical Abstract of the United States, 1926 (Washington, D.C.: U.S. Department of Commerce, 1927), 13. 206 persisted in working the more lucrative industrial jobs instead of returning to their traditional servant work.5

The Great Migration created problems for both the migrants and the blacks already living in Northern cities. Discrimination and restrictive housing covenants prevented blacks from living in many areas and increased housing prices and taxes in the small neighborhoods they could occupy.6 These real estate prices prevented new arrivals from purchasing property and made it difficult for those already settled to afford their homes.

Essentially, most African Americans in the North lived in some form of dilapidated tenement located within the bounds of a defined urban ghetto, and paid exorbitant rents to white landlords. Despite all these costs, they also lacked regular city services provided to whites, such as consistent garbage removal. This situation forced many black families to take in lodgers or even combine families into a single home, creating tight living arrangements.7 Philadelphia’s average population density in 1920 was 111 per acre, but in African American neighborhoods it was 150, while in Chicago 85% of the city’s

5 For example: the race riot in Chicago following the drowning of Eugene Williams on July 27, 1919. In Chicago the percent of African American males doing servant work decreased from 45% to 25% while those in industrial work rose from 40% to 65%, see Drake and Cayton, Black Metropolis, 232-233. In Philadelphia, the percentage of African American women working as domestic servants dropped from 87.8% in 1910 to 79.5% in 1920 and by 1930, the percentage of all African Americans working as domestic servants fell to 13%, see David McBride, Integrating the City of Medicine: Blacks in Philadelphia Health Care, 1910-1965 (Philadelphia, PA: Temple University Press, 1989), 34-37, 136-137; Bauman, Public Housing, Race, and Renewal, 29.

6 Drake and Cayton, Black Metropolis, 62; Gregg, Sparks from the Anvil of Oppression, 28-29.

7 Otis Dudley Duncan and Beverly Duncan, The Negro Population of Chicago: A Study of Residential Succession (Chicago, IL: The University of Chicago Press, 1957), 19. 207

African Americans lived in one area.8 Such overcrowding led to increased health problems and outbreaks of disease in urban areas.9

Northern racism limited not only where African Americans could live, but also their employment. African Americans in the North faced stiff competition from Eastern and

Southern European immigrants for industrial jobs, and white dominated unions excluded them. Accordingly, white businessmen often hired African Americans as strikebreakers.

This work further antagonized native whites and immigrants.10 Violence between white union members and black strikebreakers combined with white violence against blacks to keep them contained within the boundaries of the ghetto, such as Philadelphia’s South

Philadelphia.

In addition to the problems of finding a place to live and continued racial tensions, blacks arriving in the North faced two kinds of culture shock. The first involved adjusting to Northern life. The colder climate caught many Southerners who moved north unprepared.11 Whereas simple layering often sufficed during Southern winters, the snow and wind that pounded the North required a different wardrobe. New arrivals had to figure out how to balance their limited finances to buy boots and warm coats, while also

8 Gregg, Sparks from the Anvil of Oppression, 28-29; Arnold R. Hirsh, Making the Second Ghetto: Race and Housing in Chicago 1940-1960 (Chicago, IL: University of Chicago Press, 1998), 3. Kenneth Kusmer documents a similar trend towards black population density; see Kusmer, A Ghetto Takes Shape, 161-167.

9 For example, during the Great Migration period, blacks in Cleveland had an increase in infant mortality, pneumonia, tuberculosis, and venereal disease. See Kusmer, A Ghetto Takes Shape, 221, 175.

10 For more on the African American role in strikebreaking, see Stephen H. Norwood, Strikebreaking and Intimidation: Mercenaries and Masculinity in Twentieth-Century America (Chapel Hill, NC: The University of North Carolina Press, 2002), 78-113.

11 Farley, Growth of the Black Population, 70. 208 paying excessive rents. The second shock concerned adjusting to urban life. The changes in lifestyle, the crowded conditions, and the cold winters left Southern migrants particularly vulnerable to disease. They required lessons on what proper living, sanitation, and cleanliness looked like.12

In terms of health, living closer to medical professionals did not necessarily mean greater access to them. The historian Christopher Reed explains that like other urban areas, in Chicago, “Working-class individuals did without essential care until emergencies arose,” because “health care…was limited by income and racist exclusions to about six hospitals.”13 Negro Health Week’s focus on community sanitation and cleanliness had the potential to fill this educational void and improve black urban health.

While the Week had mostly been a Southern phenomenon, the Great Migration increased the Week’s reach into the North. The Week also had the potential to help unite these new arrivals and old residents against the common enemy of ill health, creating a more cohesive community.14

World War I also affected the content of health campaigns. During the war, the U.S. military classified 30% of recruits as “physically unfit.”15 This number shocked

12 McBride, Integrating the City of Medicine, 78.

13 Christopher Robert Reed, The Rise of Chicago’s Black Metropolis, 1920-1929 (Urbana, IL: University of Illinois Press, 2011), 63. Other historians have documented similar barriers to care for African Americans. See for example Kusmer, A Ghetto Takes Shape, 181.

14 On the hostility between new black arrivals and older residents, see for example Gregg, Sparks from the Anvil of Oppression, 15; Allan B. Ballard, One More Day’s Journey: The Story of a Family and a People (New York, NY: McGraw-Hill Book Company, 1984), 198; Bauman, Public Housing, Race, and Renewal, 32-33.

15 Carol R. Byerly, Fever of War: The Influenza Epidemic in the U.S. Army during World War I (New York, NY: New York University Press, 2005), 32; Annual Report of the Surgeon 209

Americans and led to the creation of the National Child Health Council, which focused on health education in schools to combat poor fitness at an early age.16 Although this organization focused its efforts mostly on white students, NHW had the potential to address the fitness of black school children.

To handle the growing diversity of the Week’s target audience and its increasing variety of health issues, Moton sought to cement partnerships with other groups. He wanted help with publicity and organization, and hoped for financial support. In 1921 he found a partner.

NHW and the PHS: The Request

On March 2, 1921, Moton sent a letter to U.S. Surgeon General Hugh Cumming requesting that the PHS support NHW. What Moton asked was simple. He wanted

Cumming to send a letter “to the various Public Health Service officers and other agencies under your supervision, calling attention to the Health Week and asking that they cooperate with the colored people in this effort for health improvement.”17 From

Moton’s perspective, the PHS could help local organizers in several ways. First, simply by publicly stating its support, the PHS would legitimize the Week. The backing of the

General of the Public Health Service of the United States: for the Fiscal year 1919 (Washington, D.C., Government Printing Office, 1919), 17.

16 Richard A. Meckel, Classrooms and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870-1930 (Piscataway, NJ: Rutgers University Press, 2013), 158- 184. The entire book is on the health education movement in schools, but focuses on white schools. The American Red Cross, national Child Labor Committee, National Tuberculosis Association, American Child Hygiene Association, and the Child Health Organization of America created the National Child Health Council in 1920.

17 Moton’s words are quoted in “National Negro Health Week,” Public Health Reports 36(11) March 18, 1921: 559-592, 560. 210

United States government would give the Week much more validity in the eyes of both whites and blacks, thereby encouraging participation. Second, the PHS’ connections to various state, county, and city health departments would provide more groups for the

Week to work with. It had the potential to make NHW into National Negro Health Week.

Third, the PHS would act as an extra media outlet. Fourth, the PHS’ connections to many white public health officials would create more opportunities for interracial work and permit more whites to see blacks practicing “proper” health. As a Washington disciple,

Moton thought that these practices would not only improve black health and income, but also encourage more white aid in supporting black self-help efforts.

It is important to remember that Moton thought the Week could benefit from the PHS with as little as a letter. Moton did not ask the PHS to organize NHW meetings, or even pay for NHW expenses. He did not need the PHS to review NHW bulletins. All he wanted was a letter of recommendation sent to PHS employees and other officials telling them about NHW and encouraging them to support the campaign. What Moton got was much more.

When Moton’s letter arrived at the desk of Hugh Cumming, it carried more weight behind it than would reasonably be expected from a regional minority health campaign.

While Moton’s stature as the principal at Tuskegee Institute made him a popular figure to

African Americans, his work as an advisor to President Woodrow Wilson gave him influence with elite whites as well. During World War I the President asked Moton to go to France to assess the conditions of black troops there and increase morale. Moton’s speeches emphasized accommodation, noting that black soldiers should not expect the 211 same freedoms in America they had enjoyed in France, and should be content with this situation.18

Moton’s service to the country, and his support of the status quo when it came to black discrimination, led to greater white interest in his work as health became an important issue in the national consciousness. Following the Annual Tuskegee

Conference in February of 1921, Tuskegee held a special meeting of health organizations to coordinate participation in the Week. In addition to Monroe Work, those attending included representatives from the American Social Hygiene Association, the National

Child Welfare Association, and Roscoe Brown, a black dentist serving as the director of

Colored Work for the PHS.19

From Hugh Cumming’s perspective, Moton’s letter represented an opportunity to enhance the PHS’ credentials in work that aligned with its goals. By 1920, the PHS had shifted its focus from operating hospitals for sailors to being in charge of inspecting newly arrived European immigrants, setting up quarantines for outbreaks of disease, and starting local and state health departments.20 Yet as the medical historian Susan Reverby

18 For more on Moton in France, see Robert R. Moton, Finding a Way Out: An Autobiography. 1920. Reprint, (New York, NY: Negro Universities Press, 1969), 250-265; Nina Mjagkij, Loyalty in Time of Trial: The African American Experience During World War I (New York, NY: Rowman & Littlefiled Publishers, Inc., 2011), 115; Robert J. Blakely and Marcus Shepard, Earl B. Dickerson: A Voice for Freedom and Equality (Evanston, IL: Northwestern University Press, 2006), 33-34.

19 “Set National Health Week for April 3-9,” Chicago Defender, February 12, 1921, 1. Brown had started work at the PHS in the Division of Venereal Disease. See Angela Castellanos, “Federal Government and African-American Communities Identifying and Defining African- American Health Disparities Through Intervention: The National Negro Health Week Movement and Office of Negro Health Work From 1915–1951,” doctoral dissertation, Harvard Medical School, Cambridge, MA, 2015, 25.

20 Thomas Parran Jr., “The National Government of the United States in Relation to the Health of its Citizens,” February 10, 1938, 1-2, T27.2:N213, box T 702, “Publications of the 212 explains, “‘Cleaning up’ was always central to the service’s expanded role; the provision of privies and clean water was often at the core of its public health work.”21 PHS work with the Week to improve black health matched the Service’s philosophy and would also help to further demonstrate its utility. Cumming likely hoped that a successful campaign would convince Congress to provide more funding for the PHS.22

NHW also presented a useful public relations opportunity for the Republican Party hierarchy that dominated national government in the 1920s. Blacks were increasingly angry at the Party during the decade. They sat silently as President Woodrow Wilson refused to support the passage of anti-lynching legislation, fired black government employees, provided little patronage to black political leaders, and segregated the federal government. Supporting the Week meant GOP members seeking the black vote could point to the PHS to demonstrate how they helped blacks. They could also point to

Moton’s service as an advisor to Republican Presidents Calvin Coolidge and Herbert

Hoover. Much of Moton’s work involved promoting the administration and placating blacks by showcasing federal support for causes that served them, such as NHW.23

Cumming accepted Moton’s proposal and, with Brown’s guidance, swiftly put the weight of the PHS behind the campaign. First, Cumming sent a letter to all public health

Federal Government,” Record Group (RG) 287, National Archives and Records Administration, College Park, MD (NARA II); Susan M. Reverby, Examining Tuskegee: The Infamous Syphilis Study and its Legacy (Chapel Hill, NC: The University of North Carolina Press, 2009), 19-21.

21 Reverby, Examining Tuskegee, 19.

22 John W. Ward and Christian Warren, eds., Silent Victories: The History and Practice of Public Health in Twentieth-Century America (New York, NY: Oxford University Press, 2007), v.

23 For a brief overview of the problems African Americans had with the Republican Party, see David Greenberg, “The Party of Lincoln…: But not of Hayes, Harrison, Hoover, Eisenhower, Nixon, Reagan, or Bush,” slate.com 10 August 2000, < https://slate.com/news-and- politics/2000/08/the-party-of-lincoln.html> (31 January 2020). 213 officers asking them to cooperate in NHW.24 PHS’ reach to all parts of the country changed NHW into a truly national campaign, now appropriately called National Negro

Health Week (NNHW). Second, Brown convinced Cumming to take on the financial and organizational responsibility for publishing materials on the Week’s behalf, including the

Week’s health bulletin, and otherwise promoting the Week.25

The PHS’ efforts publicizing the Week were more than Moton could have hoped for.

While Moton and Work had some access to financial resources from the Tuskegee

Institute, the National Negro Business League, the Phelps Stokes Fund, and a few other groups, they generally tried to keep costs low. This focus restricted the ways in which they advertised. As discussed earlier, the Week’s leaders placed most advertisements in black publications and neighborhoods. Although this strategy targeted the Week’s audience, it obstructed many whites from learning about the Week. As a federal agency, the PHS could easily increase white cooperation and participation through its publicity arms. Additionally, the PHS’ willingness to take on the costs of the Week allowed

NNHW leaders to reallocate funds to make its advertisements and promotions towards

African Americans more impactful. Thus, PHS promotion not only encouraged more white participation and interracial work on health, but it also fostered greater black participation.

24 “National Negro Health Week,” Public Health Reports, March 18, 1921, 36 (11): 559- 592, 560; “National Health Week To Be Fully Observed,” New York Age, March 26, 1921, “Tuskegee Health Collection (THC), 1921,” 298, TA.

25 Roscoe C. Brown, “The National Negro Health Week Movement,” Journal of Negro Education 6, 1937: 553-564, 558; “In Memoriam: Dr. Monroe N. Work, Tuskegee Institute, Ala.,” National Negro Health News (NNHN), vol. 13, no. 2, April-June, 1945, 24. 214

Another way in which the PHS would help promote the Week was “In carrying out a year-round program on health improvement.”26 The National Negro Business League

(NNBL) had envisioned this effort, but it had gained little traction.27 A year-round program required greater funding and increased coordination. By 1921, the Week’s leaders had congratulated themselves on simply getting a variety of groups and people to agree on what to do for one week. To get them to agree on a whole year seemed farfetched. Yet the concept of a year-round health program interested the PHS. Such a campaign would give the PHS ample time to generate interest and publicity. A year- round campaign also was a grander concept than one just a week long, making NNHW a more significant undertaking. However, if the PHS was to participate in a year-round campaign, it would need to share in the creation of the Week’s health publications. Given the opportunity to deliberate on methods to improve black health, the Service began to reorient the focus of the Week. The Week’s emphasis on personal cleanliness strategies remained, but NNHW also gave increased attention to the importance of seeing licensed medical professionals. As the Week grew in stature, the role of the physician in health and health care grew as well. At the same time, advice about what people could do on their own to improve their health decreased.

Other NNHW Partners

26 “National Negro Health Week,” Public Health Reports 36(11) March 18, 1921: 559-592, 560.

27 “Negro Health Week,” Nashville Globe, July 19, 1919, “THC 1920,” 552, TA. 215

The PHS was not the only organization impressed with the early growth of NNHW.

The Commission on Interracial Cooperation (CIC), a voluntary association of mostly white southern leaders focused on improving relations between the races, quickly moved to get involved. Founded in 1919 after several urban riots in northern cities, the CIC did not include the elimination of segregation or equal rights for blacks under its “improving relations” directive.28 However, the Week’s focus on general support for blacks and their health, and generating white support for black health work, aligned with the

Commission’s goals since health issues concerned both races. Thus, NNHW provided the

Commission with a valuable opportunity to increase the CIC’s visibility. Moton’s stature as a member of the Commission influenced it to join NNHW. However, the CIC’s enthusiasm for the work was noteworthy. While still coordinating participation in the

1921 Week, the CIC’s white Associate Director Will W. Alexander asked Moton to include the CIC in NNHW plans for the following year so that it could “turn the whole thought of our Southern people during this particular week.”29 From NNHW’s perspective, the CIC’s connections with white newspapers offered another useful partner in NNHW’s efforts to improve interracial participation in the campaign.

The NMA also showed renewed interest in the Week in 1921. As discussed in the previous chapter, the NMA had a difficult relationship with the campaign in the Week’s

28 Bettye Collier-Thomas, Jesus, Jobs, and Justice: African American Women and religion (New York, NY: Knopf, 2010), 321. African Americans did eventually make their way into leadership positions in the CIC and work to change the CIC’s focus to a greater emphasis on educating whites about racial abuse and ending these practices, but this process began only after “the CIC met for a year before deciding to include African Americans.” See Collier-Thomas, Jesus, Jobs, and Justice, 321-336. Some of the most promonent riots occurred in Chicago and Washington, D.C.

29 Will W. Alexander to Robert Moton, March 8, 1921, folder 479a, box 72, RMGC, TA. 216 early years. Many NMA members rejected Washington’s accomodationist philosophy.

They saw it as preventing black advancement and supporting racial segregation instead of racial advancement.30 Although NMA President Dr. D. W. Byrd encouraged members to participate, the JNMA did not publish any of Tuskegee’s advertisements and made little mention of NHW.

But in 1921, new NMA President John P. Turner wrote to Kenney asking the

Tuskegeean to facilitate the NMA’s participation in NNHW. Turner perceived NNHW as an opportunity to get the African American public more comfortable with black physicians. He wanted NMA doctors to be lecturers, particularly on the “Health Sundays” at local churches. Such an opportunity would provide physicians with greater access to the public and the appearance of support from the respected clergy.31 With Turner’s push,

JNMA published the NNHW press release and exhorted, “All our doctors everywhere are urged to participate in the observance of this program.”32

The NMA also saw NNHW as a way to establish orthodox physicians as the primary consultants for African American health problems. As G. N. Woodward, president of the

John A. Andrew Clinical Society, explained, NNHW work would bring physicians “in contact with all classes of people in his [the physician’s] community in such a manner as to create in them greatly increased respect for, and confidence in, his professional

30 David Lazris, “Survival and Progress: The National Medical Association and Black Medical Professionalism, 1865-1929,” Bachelor of Arts Thesis, Brown University, Providence, RI, 2017, 12; Thomas J. Durant Jr., and Joyce S. Louden, “The Black Middle Class in America: Historical and Contemporary Perspectives,” Phylon 47(4) 1986: 253-263, 257.

31 John P. Turner to John A. Kenney, January 18, 1921, in “Kenney, 1919,” box 19, RMLC, TA.

32 “National Negro Health Week,” Journal of the National Medical Association (JNMA) 13(1) 1921: 64-66, 66. 217 ability.”33 As discussed in Chapter 2, the abuse and discrimination that blacks received from white hospitals, clinics, and physicians left African Americans with a great deal of mistrust towards the medical establishment. Woodward and others thought that NNHW provided black physicians the opportunity to improve the African American perception of professional medicine, or at least increase their trust in black doctors, of which there were only 3,495 in 1920.34

Furthermore, Woodward argued that the community’s “increased appreciation of the value of health and of the dangers of diseases will at the same time increase their desire for the advice and services of the doctor.”35 Once people came to understand what constituted proper health, they would be more likely to want to maintain it and seek out medical experts with greater frequency. Overall, Woodward argued that NNHW participation would make blacks more comfortable with physicians, and a greater understanding of health would encourage more to care about it. This combination would increase support for the medical practices of black physicians.

One other benefit Woodward perceived from NMA participation was the opportunity to help African Americans identify who not to trust with health problems. While NNHW gave physicians and nurses the chance to caution against the use of patent medicines and folk healers, it also provided the opportunity to work with and educate midwives.

Although some lumped this group in with those who used superstitious practices, the

33 G. N. Woodward, “Racial Health (Presidential Address),” JNMA 6(3) 1924: 177-179, 178.

34 U.S Bureau of the Census, Statistical Abstract of the United States, 1925 (Washington, D.C.: U.S. Department of Commerce, 1926), 40. The number of white physicians was 125,666.

35 Woodward, “Racial Health (Presidential Address),” 178; a similar sentiment was put forth in “National Negro Health Week,” JNMA 15(1) 1923: 51-52. 218 dearth of black physicians and nurses led Woodward to conclude that midwifery was likely to continue for the foreseeable future.36

Like some immigrant groups, African Americans used midwives due to a combination of tradition and the need for support during the birthing process. Those in the rural South especially relied on them because house calls by the few physicians available were near impossible. Instead of undermining their work, Woodward proposed using NNHW as an opportunity to educate midwives specifically, producing better midwives and improving relations between the midwife and the physician. Closer relationships between midwives and physicians would allow doctors to supervise the midwives’ work to a certain extent, and give physicians another important cultural voice of support for medical professionals in the African American community.37 His promotion of the certified midwife reflected a growing trend in the U.S. as local and state boards of health began to create licensing programs and regulations for midwives. These programs distinguished between midwives who had “official training” and those who learned “mostly from experience and community apprenticeships.”38

One issue the Week created for black physicians concerned the Week’s nonmedical leadership. Black physicians wanted the white medical establishment to accept them as

36 Woodward, “Racial Health (Presidential Address),” 178. The issue of the midwife as a user of superstitious practices was covered in Chapter 3.

37 Woodward, “Racial Health (Presidential Address),” 179. The Children’s Bureau led a similar effort to control not only black midwives, but also those of immigrants and Native Americans. It created a lot of regulations on appearance and emphasized white middle class values in exerting its authority. See Robyn Muncy, Creating a Female Dominion in American Reform, 1890-1935 (New York, NY: Oxford University Press, 1994), 110-122. For more on the role of midwives in African American life, see Chapter 3.

38 Margaret Charles Smith and Linda Janet Holmes, Listen to Me Good: The Life Story of an Alabama Midwife (Colubmus, OH: Ohio State University Press, 1996), 64-65. 219 equals.39 They wanted an end to the exclusion of black doctors from practicing in hospitals throughout the nation and an end to discrimination in medical associations and schools. Given this interest, a health campaign people outside of the medical field led raised questions about the role of doctors in leading health practices for their race. This was not a problem black physicians faced alone. The historian Barbara Melosh explains that all physicians perceived lay health work as threatening “doctors’ claims to the exclusive right to define the content and organization of medical care, to control related services, and to work without constraints from outsiders.”40 From this perspective, the

Week had the potential to destabilize not only the way black doctors conducted business, but also their standing as medical professionals.

The NMA reacted to NNHW’s challenge by working to strengthen its position within the Week so that it could assert more control over it. The NMA recommended that

“Physicians should take the lead in their communities and get every force in line to make the occasion a success.”41 Prior to 1921, doctors had usually responded to requests to participate in the Week from the local NHW committee. Few had taken on the responsibility of organizing a campaign. Such leadership would allow black doctors to eventually turn local Weeks towards health practices that focused on utilizing

39 Gretchen Long, Doctoring Freedom: The Politics of African American medical Care in Slavery and Emancipation (Chapel Hill, NC: The University of North Carolina Press, 2012), 168- 169; McBride, From TB to AIDS, 22-23; Todd L. Savitt, Race and Medicine in Nineteenth – and Early-Twentieth-Century America (Kent, Ohio: The Kent State University Press, 2007), 270-275; W. Michael Byrd and Linda Clayton, An American Health Dilemma: The Medical History of African Americans and the Problem of Race: Beginnings to 1900, vol. 1 (New York, NY: Routledge, 2000), 376.

40 Barbara Melosh, “The Physician’s Hand””: Work Culture and Conflict in American Nursing (Philadelphia, PA: Temple University Press, 1982), 129. See also Paul Starr, The Social Transformation of American Medicine (New York, NY: Basic Books, 1982), 181.

41 “National Negro Health Week,” JNMA 13(1) 1921: 64-66, 66. 220 professional medical resources. Throughout the 1920s, the JNMA continually lamented the lack of physician leadership in the Week, “As we have stated in these columns before, the physicians are the proper persons to take the lead in the observance of National Negro

Health Week.”42 To correct this perceived error, the Journal asked readers to support the

Week’s activities and attend NNHW planning conferences.43

In terms of participation, the JNMA told doctors to keep things simple. The Journal advised doctors to limit in-depth discussions of particular diseases and instead connect the health practices NNHW championed with reducing illness.44 Esoteric discussions of sickness that revealed the inner workings of a particular disease were unlikely to improve health. Additionally, they were unlikely to make listeners more comfortable with medical professionals. Given the NNHW platform, the NMA suggested doctors focus on helping people understand why the tasks NNHW recommended would ward off specific diseases.

In this way, they could both help African Americans improve their health and demonstrate their utility.

The endorsements of the NMA, CIC, and PHS combined with Moton’s efforts to promote himself as the new Booker T. Washington led a wide variety of white-led groups to support the Week. The National Tuberculosis Association (NTA), American Red

42 “National Negro Health Week,” JNMA 15(1) 1923: 51-52, 51.

43 “National Negro Health Week,” JNMA 14(1) 1922: 32; “The Washington Meeting of the National Medical Association,” JNMA 14(2) 1922: 100-101, 101; “Pennsylvania on Top,” JNMA 14(3) 1922: 163-164; “National Negro Health Week,” JNMA 15(1) 1923: 51-52; Woodward, “Racial Health (Presidential Address),” 177-179; John O. Plummer, “Annual Address of the President of the National Medical Association,” JNMA 16(4) 1924: 239-242, 240; S. M. Clark, “President’s Address: Volunteer State Medical Association,” JNMA 18(1) 1926: 21-23; “National Negro Health Week,” JNMA 18(2) 1926: 83-84; “National Negro Health Week,” JNMA 21(1) 1929: 17-18; J. R. Perry to John Kenney, January 12, 1923, folder 660, box 89, RMGC, TA.

44 “National Negro Health Week,” JNMA 14(1) 1922: 32; “National Negro Health Week,” JNMA 15(1) 1923: 51-52, 52. 221

Cross, National Child Welfare Association, American Social Hygiene Association, and both the YMCA and YWCA all declared a willingness to participate in NNHW. The New

York Age interpreted this interest as evidence “that the observance of National Negro

Health Week is in reality becoming national in its scope.”45 The New York Age hoped that these groups would help the Week move beyond the South to reach the growing numbers of urban blacks. Indeed, many of these groups focused on the urban North and already worked with Southern and Eastern European immigrants to improve their health. In addition to supporting black health improvement, this participation also signaled to

Moton that “white people are everywhere now willing and anxious to co-operate with all agencies which are working to improve Negro health.”46 While Moton exaggerated the interest of white people in African American welfare, his comment reflected the enthusiasm he felt for a campaign that would now have a true national reach.

The NNHW Bulletins of the PHS – 1921-1925

The first page of the Week’s bulletin in 1921 signaled that PHS involvement meant change for the Week. Although it listed the National Negro Business League and the

Annual Tuskegee Negro Conference as the official organizers, the bulletin noted the many other groups involved in the Week. This recognition contrasted sharply with the

45 “National Health Week To Be Fully Observed,” New York Age, March 26, 1921, “THC 1921,” 298, TA. Having more than five million members, the American Red Cross’ support suggested particular potential. Julia F. Irwin, Making the World Safe: The American Red Cross and a Nation’s Humanitarian Awakening (New York, NY: Oxford University Press, 2013), 165.

46 “National Negro Health Week,” JNMA 14(1) 1922: 55-57, 56. 222

1915 Bulletin in that it featured groups whites led.47 Later editions omitted partner organizations altogether, specifically recognizing only the PHS’ cooperation in NNHW.

While the PHS contributed a great deal of resources, the decision not to list other groups, particularly black organizations, had the potential to imply that the campaign did not interest these groups.48 Within the context of a campaign designed to improve African

American life, such a perception could harm a group’s reputation and support.

Compounding the potential perception that black organizations had little interest in the Week was the change in where African Americans should get their health information. While the 1915 Bulletin had directed people mostly to Tuskegee instead of the NMA for health advice, it had encouraged people to get health information from both black and white sources. The similar section in the 1922 and subsequent bulletins only listed the PHS and state health departments.49 Bulletins did not mention either the NMA, or Tuskegee itself as viable sources for health information. Here the PHS began to position itself to have greater authority over the future of black health. The Service’s network of state and county health departments gave it the ability to reach African

47 Such as the American Social Hygiene Association and the American Red Cross. See Program of The Eighth Annual National Negro Health Week, April 2 to 8, 1922 (Washington, D. C.: Government Printing Office, 1922), 1, T 27.2:N31 922, box T 702, “Publications of the Federal Government,” RG 287, NARA II. Program of The Seventh Annual National Negro Health Week, April 3 to 9, 1921 (Washington, D. C.: Government Printing Office, 1921), 1, T 27.2: N31, Box T702, “Publications of the Federal Government,” RG 287, NARA II. While the PHS credited the year 1921 as the seventh year of the Week, it was actually the sixth because, as noted in Chapter 3, there was no celebration in 1916. However, counting the Week from 1915 and including 1916 is done throughout the life of the NNHW.

48 “Medical Association Asks Part in Health Week Program,” Baltimore Afro-American, March 22, 1930, 7; “National Medical Association Executive Demands Recognition on Negro Health Week Program,” Pittsbu rgh Courier, March 22, 1930, “THC, 1930,” 512, TA.

49 Program of The Eighth Annual National Negro Health Week, April 2 to 8, 1922 (Washington, D. C.: Government Printing Office, 1922), 12, in T 27.2:N31 922, box T 702, “Publications of the Federal Government,” RG 287, NARA II. 223

Americans in the North and South who could not access medical professionals. At the same time, although Roscoe Brown directed much of the PHS work on NNHW, the focus on the PHS as the best source for health information limited the opportunity for black organizations to lead on health.

Yet even with these changes, the focus of NNHW remained the same: formalizing simple and cheap practices to improve health that most African Americans could apply.

As Surgeon General Cumming put it in the 1922 bulletin, “Each of us needs to think clearly and keep fit. FRESH AIR, SUNSHINE, CLEAN HOMES, GOOD FOOD; a proper portion of WORK, PLAY, REST and SLEEP. These sum up the road to health.

KEEP FIT.”50 The capitalized words all involved activities that people, regardless of education or income, could accomplish on their own and would help ward off disease.

Fresh air and sunshine would help fight tuberculosis.51 Clean homes and sanitary privies would combat flies and rats, which carried typhoid, dysentery and other illnesses. Good food would help improve the common issue of constipation.52 Given that racism

50 Program of The Eighth Annual National Negro Health Week, April 2 to 8, 1922 (Washington, D. C.: Government Printing Office, 1922), 2, in T 27.2:N31 922, box T 702, “Publications of the Federal Government,” RG 287, NARA II.

51 While physicians at the time recognized the curative properties of sunshine, they attributed sunshine to changes in metabolism that allowed people to fight tuberculosis better. See for example R. I. Harris, “Heliotherapy in Surgical Tuberculosis,” AJPH 16(7) 1926: 687-694. Today, we know that ultraviolet light makes vitamin D which helps create an immunity to tuberculosis. See for example William A. Wells, “Curing TB with sunlight,” Journal of Cell Biology 172(7) 2006: 958.

52 See Program of The Eighth Annual National Negro Health Week, April 2 to 8, 1922 (Washington, D. C.: Government Printing Office, 1922), 1-7, T 27.2:N31 922, box T 702, “Publications of the Federal Government,” RG 287, NARA II. Program of The Seventh Annual National Negro Health Week, April 3 to 9, 1921 (Washington, D. C.: Government Printing Office, 1921), 7-9, T 27.2: N31, Box T702, “Publications of the Federal Government,” RG 287, NARA II; National Negro Health Week, April 1 to 7, 1923, The Ninth Annual Observance (Washington, D. C.: Government Printing Office, 1923), 1-10, folder 660, box 89, RMGC, TA; National Negro Health Week, March 30 to April 5, 1924, The Tenth Annual Observance (Washington, D. C.: 224 continued to prevent most African Americans from accessing physicians, clinics, and hospitals, the focus on cleanliness still seemed the best way to improve black health. It could address a number of health problems closely related to poverty, particularly useful for the black majority in the South.

Under the PHS, the Week’s daily themes reflected more of a community focus. While previous Weeks concentrated on house and yard cleaning, whitewashing, and painting, during the 1920s the focus moved beyond the individual efforts in the home. Sermon and

Lecture Day, Hygiene Day, Swat the Fly Day, Children’s Health Day, Church Sanitation

Day and General Clean-Up Day all still emphasized how common folk could improve health without a physician. However, they encouraged people to work together to improve their local church, remove fly and mosquito breeding grounds in their neighborhoods, and improve health community wide.

Children’s Health Day captured this idea. The bulletin advised school leaders to teach health concepts. The 1924 and 1925 bulletins included “A Program of Health Habits for

Children” to formalize this instruction. The “Program” covered everything from the types of foods children should eat to the number of hours they should sleep and play and was similar to instruction given to poor white and European immigrant students. The effort here was to routinize behavior, not explain why such measures were necessary. None of

Government Printing Office, 1925), 3-6, T 27.2: N31 924, box T702, “Publications of the Federal Government,” RG 287, NARA II; National Negro Health Week, April 5 to 11, 1925, The Eleventh Annual Observance (Washington, D. C.: Government Printing Office, 1925), 3-6, folder 1032, box 132, RMGC, TA. 225 the 11 Habits came with any reasoning or connection to overcoming specific health concerns.53

Yet Children’s Health Day was about much more than just health education for students. Like the NTA, NNHW leaders continued to perceive children as a mechanism to excite the whole African American community about health. To generate greater interest, leaders moved the Day to fall on the anniversary of Washington’s birth.54

Suggestions for how to follow Children’s Health Day included organizing health parades in schools and telling stories about various health “crusades,” that is, public health campaigns and campaigners. This latter effort was a similar tactic to that used in the school hygiene movement aimed at white children.55 The bulletin advised schools to encourage parents to attend the parades and other activities as a way to stimulate the whole family to participate in the Week. If these activities were too much work, the bulletin explained that the easiest way to observe the day, much like the rest of the Week, was simply to clean the school and talk about Booker T. Washington.56 In this way,

Children’s Health Day functioned, at its most basic level, as another clean-up day.

53 National Negro Health Week, March 30 to April 5, 1924, The Tenth Annual Observance (Washington, D. C.: Government Printing Office, 1925), 9, T 27.2: N31 924, box T702, “Publications of the Federal Government,” RG 287, NARA II; National Negro Health Week, April 5 to 11, 1925, The Eleventh Annual Observance (Washington, D. C.: Government Printing Office, 1925), 9, folder 1032, box 132, RMGC, TA. For similarity to programs aimed at white children, see Meckel, Classrooms and Clinics, especially 132.

54 The placement of Children’s Health Day on this date started when the PHS partnership with NNHW began in 1921, see Robert Moton, “National Negro Plan Health Week April 3, to April 9,” Atlanta Independent, March 3, 1921, “THC 1921,” 296, TA.

55 The school hygiene movement used the idea of “Health Heroes” in schools. See Meckel, Classrooms and Clinics, 185.

56 See for example Program of The Seventh Annual National Negro Health Week, April 3 to 9, 1921 (Washington, D. C.: Government Printing Office, 1921), 1, T 27.2: N31, box T702, 226

The involvement of the PHS and other white health organizations did alter the Week in a couple of ways. The first involved a focus on specific diseases. The NTA’s involvement, combined with TB’s status as a major health concern for African

Americans, contributed to the creation of Tuberculosis Day. Venereal disease education, a target of the American Social Hygiene Association, became a key component of

Hygiene Day. Although past Week’s had included discussions about disease, during

NNHW the emphasis was usually on how a particular practice could combat illness. For instance, discussions about hookworm focused on how to build sanitary privies because the most common way to contract hookworm was through stool. Indeed, since TB was a highly contagious disease without a cure, the bulletin’s advice was simply ““1. Good cheer. 2. Good food. 3. Fresh air. 4. Proper living.”57

However, having a day of the Week dedicated exclusively to a particular disease was a significant change and illustrated a growing interest in NNHW participants having a detailed understanding of illnesses. Tuberculosis was the only disease mentioned in the

1915 Bulletin and its discussion was brief. With PHS participation, the bulletin’s focus on particular diseases and their symptoms expanded to include hookworm, venereal disease, typhoid, malaria, pellagra, pneumonia, and diphtheria. This emphasis on

“Publications of the Federal Government,” RG 287, NARA II; Program of The Eighth Annual National Negro Health Week, April 2 to 8, 1922 (Washington, D. C.: Government Printing Office, 1922), 3, in T 27.2:N31 922, box T 702, “Publications of the Federal Government,” RG 287, NARA II.

57 Program of The Eighth Annual National Negro Health Week, April 2 to 8, 1922 (Washington, D. C.: Government Printing Office, 1922), 3, 9, in T 27.2:N31 922, box T 702, “Publications of the Federal Government,” RG 287, NARA II. The 1921 bulletin has the same suggestions; see Program of The Seventh Annual National Negro Health Week, April 3 to 9, 1921 (Washington, D. C.: Government Printing Office, 1921), 9, T 27.2: N31, box T702, “Publications of the Federal Government,” RG 287, NARA II. 227 understanding disease was new and suggested the need for a medical professional’s expertise. It also created a niche for white public health organizations, such as the NTA.

The NTA supported local NNHW committees and even ran some of its campaigns alongside NNHW so that the two programs could reinforce each other.58 Lastly, the white majority associated most of these diseases with “bad behavior,” meaning that an African

American health campaign that focused on them had the potential to perpetuate negative associations between health and race.59

Thus, the new focus on disease opened the door to the second alteration in the Week: carving out a larger role in the 1920s for physicians. Bulletin’s published under the auspices of PHS between 1920 and 1925 aimed more at urban migrants and highlighted the important roles physicians played in improving health. A particular point of emphasis was the need for vaccinations and medical professional intervention, such as the Schick test to detect diphtheria.60 Indeed, as opposed to the NHW’s 1915 Bulletin, which

58 “National Negro Health Week,” Summerville Gazette, April 7, 1927, “THC, 1927,” 442, TA; “Adults’ Day for Negro Health Week Here,” Jersey City Journal, April 6, 1927, “THC, 1927,” 443, TA; “Negro Health Week to be Marked Here,” Newark News, March 30, 1927, “THC, 1927,” 443; “Public Health Association to Assist in Work,” Houston Informer, “THC, 1930,” 514, TA. Tennessee’s supervisor of Negro Welfare explored this idea of combining an anti-tuberculosis drive with NNHW as well, see “Spotlight Turned on T.B. Problems at Memphis Meet,” Chicago Defender, May 17, 1930, 3.

59 Castellanos, “Federal Government and African-American Communities,” 40.

60 Program of The Seventh Annual National Negro Health Week, April 3 to 9, 1921 (Washington, D. C.: Government Printing Office, 1921), 3, 7-10, T 27.2: N31, box T702, “Publications of the Federal Government,” RG 287, NARA II; Program of The Eighth Annual National Negro Health Week, April 2 to 8, 1922 (Washington, D. C.: Government Printing Office, 1922), 3, 8-11, in T 27.2:N31 922, box T 702, “Publications of the Federal Government,” RG 287, NARA II; National Negro Health Week, April 1 to 7, 1923, The Ninth Annual Observance (Washington, D. C.: Government Printing Office, 1923), 1-10, folder 660, box 89, RMGC, TA; National Negro Health Week, March 30 to April 5, 1924, The Tenth Annual Observance (Washington, D. C.: Government Printing Office, 1925), 3-6, T 27.2: N31 924, box T702, “Publications of the Federal Government,” RG 287, NARA II; National Negro Health Week, April 5 228 targeted mostly southern blacks, the majority of whom resided in rural areas, and which buried advice to get vaccinated within its long list of health rules, later bulletins were more overt. They printed in capital letters “HAVE YOUR DOCTOR EXAMINE YOU

CAREFULLY ONCE A YEAR,” and defined what seeing a doctor entailed: “an examination of the teeth…urine, blood, record of blood pressure…[and] stool.”61 Later bulletins also included a full page description of what to expect during a doctor’s visit and photographs of an exam.62 Such explanations were not limited to blacks. People throughout the country wrote to the PHS during the 1920s asking for “a definite outline as to what an examination should cover.”63

NNHW still encouraged a wide range of people, medical and non-medical, to discuss diseases. However, the growing space given to disease description and medical professional usage left less room for discussing individual prevention strategies and

to 11, 1925, The Eleventh Annual Observance (Washington, D. C.: Government Printing Office, 1925), 3-6, folder 1032, box 132, RMGC, TA.

61 Program of The Seventh Annual National Negro Health Week, April 3 to 9, 1921 (Washington, D. C.: Government Printing Office, 1921), 8, T 27.2: N31, box T702, “Publications of the Federal Government,” RG 287, NARA II; Program of The Eighth Annual National Negro Health Week, April 2 to 8, 1922 (Washington, D. C.: Government Printing Office, 1922), 7, in T 27.2:N31 922, box T 702, “Publications of the Federal Government,” RG 287, NARA II; National Negro Health Week, April 1 to 7, 1923, The Ninth Annual Observance (Washington, D. C.: Government Printing Office, 1923), folder 660, box 89, RMGC, TA; National Negro Health Week, March 30 to April 5, 1924, The Tenth Annual Observance (Washington, D. C.: Government Printing Office, 1925), 12, T 27.2: N31 924, box T702, “Publications of the Federal Government,” RG 287, NARA II; National Negro Health Week, April 5 to 11, 1925, The Eleventh Annual Observance (Washington, D. C.: Government Printing Office, 1925), back cover, folder 1032, box 132, RMGC, TA.

62 “National Negro Health Week: April 1 to 8, 1928,” PHS, Washington, D.C., 1928, 18, T27.2:N31/928, OUL; “National Negro Health Week: Fifteenth Annual Observance (1929), Sunday, March 31, to Sunday, April 7,” PHS, Washington, D.C., 1929, 13-14, folder 21, box 2, NNHW, TA; “National Negro Health Week: Sixteenth Annual Observance {1930}, Sunday, Mary 30, to Sunday, April 6,” PHS, Washington, D.C., 1930, back cover, folder 3, box 1, NNHW, TA. .

63 Donald B. Armstrong, “See Your Doctor,” The Survey: Social, Charitable, Civic: a Journal of Constructive Philanthropy (The Survey) 58(7) July 1, 1927: 386-388 & 393-397, 388. 229 practices. More importantly, this changed focus suggested that the PHS and its urban partners did not understand their target audience. Most African Americans remained in the South without access to medical professionals.

It is important not to overstate these changes. Many physicians already participated in the Week and more than half of the Week still focused on cleaning and painting.

Additionally, the small number of black medical professionals made the participation of non-medical professionals and their groups vital to the Week’s success. While the PHS provided a great deal of support and publicity, it still lacked the reach into the African

American communities of the South. This situation made those outside of the medical establishment vital to the NNHW health education campaign. However, the increased focus on the knowledge of medical professionals signaled the limitations of routinized health practices. In short, under the PHS, the bulletin began to assert that what one did externally was not as important to health as what one did internally. These changes indicate that the PHS would concentrate more on large northern and western urban centers with large black populations than the rural balcks in the South the campaign had focused on prior.

The Effects of the PHS on Organizing NNHW

As discussed earlier, the intervention of the PHS changed the economics of NNHW.

Prior to PHS participation, Monroe Work guided the printing of the bulletin and press releases, as well as write individualized letters to black newspapers, schools, churches, medical associations, women’s clubs, other groups, state health departments, and even 230 governors to generate public support.64 With the PHS’ involvement, the PHS could reach out to health departments and associations directly, defraying the time and costs needed for NNHW. The PHS decision to print the Week’s bulletin saved NNHW even more money. These savings allowed Moton and Work to use a $6,000 budget for NNHW.

Of that $6,000, almost half went to postage, stationary, and travel as Moton and Work organized speakers at different Weeks and sent letters to various black organizations to get them involved. Most of the rest went into the creation and financing of the NNHW bulletin. Although the PHS agreed to print these bulletins, it only printed a specific amount for free. The NNHW leadership worked to fill the gap between what the PHS printed and what the campaign needed. Here it relied on Tuskegee and the donations of other national and local partner organizations to make the bulletin more accessible.65

Local NNHWs also tried to keep costs low. Most organizers worked on a volunteer basis and counted on donations from various local groups. To save money, the PHS encouraged groups to reprint the NNHW bulletin at their leisure. These low cost strategies were a necessity in the rural South where African American organizations and health departments had little reach. Those campaigns that had greater access to the

NNBL, National Association of Colored Women (NACW), and other black groups still

64 Monroe Work to Albon Holsey, February 22, 1921, Folder “Work,” box 26, Robert Moton Local Correspondence (RMLC), TA; McMurry, Recorder of the Black Experience, 116.

65 Tuskegee Institute, “PROPOSED BUDGET FOR OUTSIDE HEALTH ACTIVITIES,” n/d, folder “Kinney/Dibble,” box 32, RMLC, TA, it is apparent the budget is for 1924; “PROPOSED BUDGET FOR OUTSIDE HEALTH ACTIVITIES,” n/d, folder “Work,” box 38, RMLC, TA. It is apparent this budget, which is the same as that in the “Kinney/Dibble” folder but has different items listed elsewhere, is for 1925; Secretary to Principal to Winifred C. Putnam, November 10, 1922, folder 660, box 89, RMGC, TA, this notes that the National Information Bureau budgeted $500 for NNHW this year; Robert Moton to Mark J. White, October 30, 1922, Folder 660, Box 89, RMGC, TA; “National Race Health Week Is Announced Here,” Houston Informer, March 14, 1925, “THC 1925,” 161, TA. 231 spent very little. Kansas City’s 1923 observance included clinics and lectures that reached 25,000 people, but cost only $69.66

As predicted, PHS endorsement of NNHW stimulated more white public officials to encourage participation. The governors of Georgia, North Carolina, and Oklahoma issued statements of support for NNHW, and those in Maryland, Texas, and Delaware followed later in the decade.67 The Department of Agriculture also began to participate and sent personnel to conduct demonstrations on ways to farm and organize the home to achieve better health.68 The Commission on Interracial Cooperation also played an important role.

Affiliates in Louisiana, Georgia, Kentucky, and Tennessee helped organize state-wide

Weeks in the early 1920s. The white members of the committees often worked with city and county officials to get permits and financial support for the Week, while the black members worked with local African American communities to identify their needs. By

1924, the CIC had become one of the principal organizing agencies for NNHW in the

South, distributing NNHW material throughout its 800 branches in 15 states. 69

66 “Attucks School Wins in Health Week Contest,” Kansas City Sun, April 13, 1923, “THC 1923,” 781-782, TA.

67 “Negro Health Week Named By Governor,” Atlanta Evening Journal, March 19, 1921, “THC 1921,” 317, TA; “Negro health Week named By Governor,” Atlanta Constitution, March 19, 1921,” “THC 1921,” 317, TA; “Negro Health Week,” Wilmington Star, April 1, 1921, “THC 1921,” 308, TA; “Negro Health Week Will Start Today,” Ashville Citizen, April 3, 1921,” “THC 1921,” 308, TA; “Negroes Urged To Keep Clean-Up Week,” Frederick Leader, April 2, 1921, “THC 1921,” 309, TA; “Negro Health Week Planned,” Wilmington Journal, April 1, 1927, “THC, 1927,” 402, TA; “Negro Health Week to be Held April 1-8,” Wilmington Every Evening, March 29, 1928, “THC, 1928,” 332, TA; “Bishop Jones Lectures Before Large Crowd at Wilimngton; Negro Health Week Observed,” Philadelphia Tribune, April 5, 1928, 3; “Negro Health Week On,” Knoxville Journal, April 5, 1930, “THC, 1930,” 516, TA; Dan Moody, “Proclamation by the Governor,” February 18, 1930, Folder 4, Box 4, NNHW Collection, TA.

68 “Health Week Begins Sunday,” Savannah Tribune, March 24, 1923, “THC 1923,” 795, TA.

232

State-wide organization was a significant change for NNHW. Prior to PHS endorsement, there was little NNHW coordination within states and most areas observed independently of each other. Although state boards of health had participated, they generally preferred to print health pamphlets rather than actively organizing the Week.

After Cumming embraced NNHW, the participation of boards of health of all types increased, as did the scope of organizing. The statewide campaigns of Kentucky,

Louisiana, Georgia, and Tennessee had more aid and support from the state boards of health than earlier efforts. In addition to Cumming’s support, this work was also a reaction to the white citizens who hired black domestic servants and pressured local and state governments to help ensure the health of their workers. Yet most state health departments were not prepared to lead NNHW. The costs were high and most prioritized other areas of health. This was particularly true in the South, where the Southern medical establishment continued to try to limit African American efforts to build medical colleges, hospitals, or public health campaigns.70

All the newfound support from the PHS and other public health groups did not change NNHW leaders’ reliance on their base of African American support. The NNBL continued to hand out NNHW awards at its annual meeting. The Business League also

69 “Negro Health Drive to Start in New Orleans,” New Orleans Item, March 31, 1922, “THC 1922,” 658, TA; “Negroes Asked to Observe Health Week,” Louisville Times, March 28, 1921, “THC 1921,” 300, TA; “Observance to be State-Wide,” Louisville Post, March 25, 1922, “THC 1922,” 681, TA; “Negro health Week Is March 30-April 5,” Knoxville Journal and Tribune, March 22, 1924, “THC 1924,” 574, TA; Samuel Kelton Roberts, Jr., Infectious Fear: Politics, Disease, and the Health Effects of Segregation (Chapel Hill, NC: University of North Carolina Press, 2009), 291; “Plan Mapped for a Negro Health Week,” Atlanta Georgian, March 31, 1922, “THC 1922,” 656, TA; “National Health Week March 30 to April 5,” Journal and Guide, February 2, 1924, “THC 1924,” 602, TA; “Nat’l Health Week March 30-April 5,” Philadelphia Tribune, February 2, 1924, 7; “Health Week Begins Sunday,” Savannah Tribune, March 24, 1923, “THC 1923,” 795, TA.

70 McBride, From TB to AIDS, 27. 233 advised its local affiliates to create a standing committee to support NNHW, and listed the Week as one of its achievements in recruiting new members.71 Between 1920 and the

1950s, throughout the nation, numerous local chapters and branches of the NACW,

NAACP, Urban League, black sororities and fraternities sponsored programs and supported the NNHW.

Local NNHWs and New Developments

For the most part, the events and participants of local Weeks remained similar to those prior to PHS involvement. According to Dr. D. A. Bethea, the minister “is the real leader of the Race,” and the church was still the main organizing mechanism for the

Week.72 To reduce the work of church leaders, Moton appointed a committee to create generic sermons. He even sent the sermons to health officers to aid them in recruiting local clergy who could simply read the sermon, making participation easy.73 These standard sermons included biblical quotes emphasizing the importance of good health and a particular health issue to target. The inclusion of lines such as “Do not put the

71 The Local Negro Business League: Containing Plans For Organizing and Suggestions For Local Work (Tuskegee, AL: National Negro Business League, 1923), 7, folder 2, box 21, National Negro Business League collection, TA; Why there should be a LOCAL BRNACH of the National Negro Business League in your city, N/D, Folder “NNBL – 1927 – Literature Programs, etc.” box 8, Albon Holsey Colleciton (AH), TA.

72 D. A. Bethea, “Health Week,” Southwestern Christian Advocate, March 30, 1922, “THC 1922,” 676, TA.

73 William N. Braley to “Tuskegee Institute,” March 14, 1929, folder 3, box 2, NNHW, TA; Robert Moton to “City Health Officer, Charleston, SC” January 30, 1930, folder 1, box 1, NNHW, TA; Robert Moton to “City Health Officer,” January 27, 1930, folder 1, box 1, NNHW, TA. 234 blame for this mortality on G-d,” reinforced personal responsibility for health problems and that blacks had the power to control their own health.74

The sermons also emphasized the important role of black leaders, such as ministers, who had access to large numbers of poor and rural blacks. The Tuskegee Messenger, read mostly by Tuskegee graduates, stated that “The people for the most part do not know the laws of health.”75 It was important that a sermon on health stress that people could fight disease on their own, that they could limit the impact of disease on their health by adopting healthy living habits, “The great secret of health…is personal cleanliness inside and outside, and also cleanliness of surroundings.”76 Since most listeners could not afford, or did not have access to, a physician, NNHW organizers advised ministers to also discuss the ability of non-medical experts to support disease prevention.

According to Bethea, the teacher was second in line in African American leadership, and local Weeks promoted active student participation in health improvement.77 Poster and essay contests examined topics ranging from healthy ways to dispose of sanitation, to specific methods of preventing particular diseases, to the value of tooth brushes and

74 “National Negro Health Wek,” The Tuskegee Messenger, March 14, 1925, 2, TA. This was similar to the Christian Recorder’s advice in 1915, see Chapter 3.

75 “Some Suggestions for a Sermon on Health,” N/D, folder 1077, box 138, RMGC, TA. See also “National Negro Health Wek,” The Tuskegee Messenger, March 14, 1925, 2, TA.

76 “Some Suggestions for a Sermon on Health,” N/D, Folder 1077, Box 138, RMGC, TA. A similar idea of the importance of cleanliness inside and out appears in “Some Suggestions for a Sermon on Health,” 2-3, N/D, folder 11, box 1, NNHW, TA. See also “Negro Health Week Observed in State,” Montgomery Advertiser, April 4, 1926, “THC, 1926,” 810, TA;

77 D. A. Bethea, “Health Week,” Southwestern Christian Advocate, March 30, 1922, “THC 1922,” 676, TA. 235 maintaining the paint jobs on churches.78 Like the health essays, the floats and banners of health parades ranged from simple health slogans, such as “Get Up Paint Up,” to information on specific diseases, such as tuberculosis and influenza.79 Such subjects illustrated the classroom instruction students received about germs and health, and reinforced the expectation that they would think about and improve their health and that of their community.

A few NNHW programs showed particular creativity in engaging children in the

Week’s programming. Some had students change the words to nursery rhymes and children’s songs to remember and internalize health concepts.80 In Kansas City, students

78 “Negro Health Week! How About Your Health?” Pittsburgh American, April 6, 1923, “THC 1923,” 773, TA; “High School Notes,” Chicago Defender, May 31, 1924, A6; “Attucks School Wins in Health Week Contest,” Kansas City Sun, April 13, 1923, “THC 1923,” 781-782, TA; “Negro Health Week Program Is Given,” Galveston News April 9, 1921, “THC 1921,” 303, TA; “Urban League Notes,” New York Age, April 7, 1921, “THC 1921,” 307, TA; “Proud Mammas See Infants Take Prizes,” Baltimore Afro-American, April 11, 1924, 1; “Essay Contest To Feature Health Week Program,” Baltimore Afro-American, March 28, 1925, 10; “National Negro Health Week Sum Is Divided Here,” Indianapolis Freemen, July 26, 1924, “THC 1924,” 594, TA; “Planning Negro Health Week,” Chattanooga Times, March 10, 1923, “THC 1923,” 768, TA; “To Observe health Week April 21-27,” Baltimore Afro-American, April 7, 1928, 11.

79 “Negroes Stage ‘Clean-Up Week’ Parade,” Atlanta Constitution, April 18, 1929, “THC, 1929,” 173, TA; “Program Arranged For Health Week,” St. Louis Argus, April 23, 1921, “THC 1921,” 301, TA; “Health Week Among Negroes Opens Today in Churches,” Harlem Home News, April 2, 1922, “THC 1922,” 668, TA; “Negroes to hear Health Sermons,” New Orleans Picayune, April 1, 1922, “THC 1922,” 658, TA; “Health Talks Given at Negro Schools,” Indianapolis Standard, April 6, 1923, “THC 1923,” 788, TA; “Health Week to be Widely Observed in Texas,” Dallas Express, March 31, 1923, “THC 1923,” 764, TA; John Kenney to Robert Moton and the Executive Council, March 7, 1924, Kenney/Dibble folder, box 32, RMLC, TA; “National Negro Health Week Sum Is Divided Here,” Indianapolis Freemen, July 26, 1924, “THC 1924,” 594, TA; “The Negroes of Durham in a Wonderful Health Campaign: Surprising Parade Yesterday,” Durham Herald, April 10, 1925, “THC 1925,” 147, TA; “Health Week Ushered in by Negro School Children in Parade,” Tampa Tribune, “THC 1925,” 124, TA. Health parades were used by a wide range of groups for a variety of causes at the time. See for example, “The Children’s Health Crusade,” The Survey 37(10) December 9, 1916, cover; “Mrs. O’Leary’s Barn Burned Again,” The Survey 37(4) October 28, 1916, 77.

80 “Negro Health Week! How About Your Health?” Pittsburgh American, April 6, 1923, “THC 1923,” 773, TA; “Report of the Annual National Health Week As Observed at Hempstead, Texas in Cooperation with Prairie View College, Prairie View, Texas,” n/d, folder 5, box 2, NNHW, TA; “Negro Health Week In Texas,” March 31-April 7, 1929, folder 6, box 2, NNHW, TA; “Report 236 competed to get people in their communities to pledge to observe NNHW. The pledge required people to participate in the Week “by learning how to live long and by cleaning up their homes and yards.”81 The pledge drive racked up 2,113 signatures. At Minor

Normal school in Chicago, students created models to demonstrate healthy living. First graders created a model playground; third graders built a miniature five-room apartment to learn about proper sanitation and ventilation; and students in home economics made salad to reinforce the value of eating raw vegetables.82

Another notable way NNHW organizers tried to interest students was by having them put on plays. These plays, like the parades and essay contests, varied based on student, school, and NNHW interests and targets. Most plays focused on proper diets and cleaning habits, having students take on the roles of bread, carrots, and apples, in addition to those of toothbrushes and “rosy cheeks.”83 All these plays shared the theme of emphasizing the importance of keeping up one’s health and attempting to explain the reasons for health recommendations. They provided another avenue to teach health practices aside from the standard lectures and teachers hoped that embodying good health practices would inculcate these ideals in young children. These plays were not just casual ways of

of Negro Health Week, March 30th – April 6th, 1930; East Carroll Parish,” folder 5, box 4, NNHW, TA.

81 “Attucks School Wins in Health Week Contest,” Kansas City Sun, April 13, 1923, “THC 1923,” 781-782, TA.

82 “High School Notes,” Chicago Defender, May 31, 1924, A6.

83 “Report of the Annual National Health Week As Observed at Hempstead, Texas in Cooperation with Prairie View College, Prairie View, Texas,” n/d, folder 5, box 2, NNHW, TA; “Negro health Week Program at City Auditorium,” Savannah Journal, April 10, 1926, “THC, 1926,” 817, TA; “Negro Health Week April 2,” Savannah Tribune, March 29, 1928, “THC, 1928,” 341, TA; “Health Pageant Staged Thursday,” Durham Herald, March 28, 1925, “THC 1925,” 146, TA. 237 enlisting students in NNHW. In Savannah, the health play was a key part of the Week’s final event, which more than 2,000 people attended.84

New strategies communities used to generate adult participation included hands-on activities. Local organizers created demonstrations on a variety of topics, including proper whitewashing techniques, infant care needs, and the ways to properly cook chicken. The latter was particularly important for formerly rural Southerners who had moved to urban centers where they could not eat the chicken they had killed just hours before. These city newcomers needed to rethink food preparation and care, adding another facet to the Week. In comparison to the work of the Department of Agriculture’s demonstration agents discussed earlier, these demonstrations focused more on specific community needs and interests.85

The use of demonstrations was not unique to African Americans. Public health associations throughout the country distributed the same information to white communities and those of Eastern and Southern European immigrants. For example, the

New York City Food Aid Committee taught Polish women “how to cook unfamiliar but wholesome and cheap vegetables in a manner familiar to them.”86 Without the

84 “Pageant to Feature Negro Health Week,” April 13, 1925, “THC 1925,” 132, TA; “Negro Health Week Was Great Success,” April 16, 1925, “THC 1925,” 133, TA. Philadelphia had one as well, see “Negro Health Week! How About Your Health?” Pittsburgh American, April 6, 1923, “THC 1923,” 773, TA.

85 “Chatham Co. Agents Observe Health Week,” Savannah Tribune, April 9, 1921, “THC 1921,” 317, TA; “Demonstration to be Conducted by Agents,” Savannah News, April 12, 1922, “THC 1922,” 654, TA; “Negro health Week to be Observed here,” Detroit Free Press, March 31, 1922, “THC 1922,” 662, TA; “Farm News,” Savannah Tribune, March 23, 1922, “THC 1922,” 675, TA; “Health Week Begins Sunday,” Savannah Tribune, March 24, 1923, “THC 1923,” 795, TA; “Negro Health Week to Be Observed in City,” Greenville News, April 3, 1924, “THC 1924,” 576, TA.

86 “The ‘Food Lady’ and Her Difficulties,” The Survey, 39(3) October 20, 1917: 70-71, 71. 238 ingredients of their native country, Polish and other immigrant communities received instruction on how to cook healthy meals in their new surroundings. The preconceived notions many Americans had about the inability of European immigrants to properly care for their children led public health officials to create child care demonstrations.87

Some NNHW campaigns began to focus on individual community health concerns. In

1921, the state of Texas made the Week’s priority removing stagnant pools of water.

These pools attracted flies and mosquitos, which in turn spread typhoid, cholera and tuberculosis.88 Atlanta too built its campaign around swatting flies due to similar concerns about disease transference.89 Baltimore’s 1924 campaign concentrated on

“eliminating indiscriminate spitting,” which a local doctor described as the primary way

TB spread.90

Women also continued to be important cogs in the NNHW machine. In Baltimore, which took second place in 1924 and first place in 1925 for its health week participation,

Elsie Mountain, head of the local Community House, led the Week and organized its subcommittees.91 In Dayton, women were the key members of the committee organizing the Week and contributed their expertise to the Week’s activities in a variety of ways.

87 See for example Elmer Scott, “Exhibit Material Wanted,” The Survey 39(15), January 12, 1918: 424.

88 “Annual Negro Health week Starts Apr. 2,” Houston Informer, April 1, 1922, “THC 1922,” 673, TA; “Texans Plan Big Fight On Fly and Mosquito,” Chicago Defender, May 7, 1921, 8.

89 “National Health Week Be Observed,” Atlanta Independent, April 3, 1921, “THC 1921,” 300, TA.

90 “Fraternities Are Active Now,” Baltimore Afro-American, March 18, 1924, 3.

91 “Plan for Health Week,” Baltimore Afro-American, March 14, 1924, 6; “Observe National Health Week,” Savannah Tribune, April 25, 1925, “THC 1925,” 117, TA; “Baltimore Wins First Prize in National Health Week,” Baltimore Afro-American, August 8, 192, 10. 239

The Dayton YWCA hosted health lectures and the women of the Public Health League conducted home visits and distributed health literature on what constituted a clean home.92

During the early 1920s, the Week expanded its use of nurses. It often included them in the baby clinics and featured them in pre-natal clinics and infant care lectures.

Elsewhere, the Visiting Nurses Association worked with cleanup committees to organize sanitation improvement.93 This inclusion of medical professionals illustrates the important role black nurses played in the community. Their training in preventive care and health instruction gave them expertise in health education. Perhaps more importantly, their work as first responders to health crises led African Americans to trust them even as many remained wary of physicians, hospitals, and other vestiges of the medical establishment.94 As the nurse Dorothy Deming put it, by the end of a public health nurse’s visit, “she has won the confidence of the family because she has shown them that she understands.”95

Another new development during the 1920s was local NNHW organizers’ growing use of the Week as a forum for discussing racial inequality and uplift. Some NNHW

92 “To Hold Negro Health Week,” Dayton News, March 25, 1923, “THC 1923,” 777, TA.

93 See for example, “Plans for Health Week Observance,” “THC 1925,” 127, TA; “Getting Ready For Negro Health Week,” Louisville Courier Journal, April 4, 1925, “THC 1925,” 136-137, TA; “Negro Health Week to Begin Tomorrow,” St. Louis Globe-Democrat, March 31, 1928, “THC, 1928,” 362, TA.

94 For more on African American nurses, see Darlene Clark Hine, Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890-1950 (Bloomington, IN: Indiana University Press, 1989).

95 Dorothy Deming, “The Negro Nurse in Public Health,” Opportunity, November, 1937: 333-335, 333. Italics in original. 240 meetings contained denouncements of Jim Crow practices.96 Others focused on unequal access to medical facilities. The Houston Informer used NNHW to decry the state of

Texas having only 40 beds available for all of its African American tuberculosis patients.97 Indeed, the sociologist Gunnar Myrdal found that in the entire United States in

1928, the ratio of hospital beds available to people was 1:139 for whites and 1:1,941 for blacks.98

Increased awareness of health care inequalities led to a greater emphasis on connecting health improvement with racial uplift, meaning that organizing around civil rights issues began to occur sporadically during the Week.99 As the Mineral Wells Index explained about NNHW in Fort Worth, Texas, “The great aim is to prepare and train the students to co-operate with all movements for civil development.”100 Here, the Week reflected some of the larger ideas surrounding the concept of the New Negro, which emphasized self-reliance and the community to improve black welfare.101 For NNHW

96 “Live 100 Years Says Senator Copeland Here,” Baltimore Afro-American, April 17, 1926, 1.

97 “The Shame of the Lone Star State!” Houston Informer, April 23, 1927, “THC, 1927), 463, TA. The situation had improved little by 1930, nor was it unusual, see for example “Negro Health Week,” San Antonio Express, March 23, 1930, “THC, 1930,” 515, TA; Kusmer, A Ghetto Takes Shape, 181.

98 Gunnar Myrdal, An American Dilemma: The Negro Problem and Modern Democracy (New York, NY: Harper & Brothers Publishers, 1944), 172.

99 Algernon Jackson, “Make Every Week a Real Health Week,” Philadelphia Tribune, April 2, 1927, 15; Algernon Jackson, “National Negro Health Week to be Observed First Week in April,” Savannah Journal, March 26, 1927, “THC, 1927,” 410, TA; “Health Week,” Chicago Defender, April 7, 1928, A2.

100 Negro Health Week Program at Dunbar High School,” Mineral Wells Index, April 6, 1928, “THC, 1928,” 381, TA.

101 McBride, Integrating the City of Medicine, xviii; Reed, The Rise of Chicago’s Black Metropolis, 18. 241 organizers, it was important to remember that health, while an important issue, was not the only concern that African Americans faced, and it was tied to issues of environment, housing, and racial discrimination.

A final notable development during the 1920s was the Week’s international expansion. In 1927, the British introduced their version of the Week to Gold Coast

Africans, while African Canadians in Montreal organized their own NNHW. These efforts, incorporated many elements of the NNHW framework. They used religious leaders to entice interest and support, and brought in physicians to give lectures on sanitation and cleanliness. The biggest differences concerned the method of participation.

The British version involved some forced participation due to its role as colonizers in

Africa. Additionally, since British officials organized the campaign, whites made up most of the leadership positions.102 This international endorsement of the Week allowed the

Week’s leaders to claim, as the Providence Tribune put it, that NNHW was “being observed throughout the world.”103

NNHW Awards

With all the Week’s changes, what it took to win an award changed as well, which led many communities to implement strategies from the best campaigns. Winning three

102 “Observe Negro health Week Here,” March 31, 1927, “THC, 1927,” 399; “British Copy Our ‘Health Week’ Idea,” Chicago Defender, March 5, 1927, 4; “West Africans Adopt Health Week Program,” Savannah Journal, March 5, 1927, “THC, 1927,” 394, TA; “West Africans Adopt Health Week Program,” Philadelphia Tribune, March 12, 1927, 9; “African Health Week,” New York Age, May 19, 1928, “THC, 1928,” 329, TA; “National Health Week Observance Will Start Sunday,” Houston Informer, March 30, 1929, “THC, 1929,” 169, TA; “Negro Health Week Observance,” N/D, Folder 2, Box 1, National Negro Health Week, TA.

103 “Negro Health Week,” Providence Tribune, April 11, 1927, “THC, 1927,” 454, TA. 242 straight NNHW awards from 1924-1926, Baltimore’s campaign, led by Elsie Mountain, was the elite example for much of the 1920s. Its success was due to several factors, the first of which was that its Executive Committee met year-round.104 Although both the

NNBL and PHS had tried to encourage year-round work on health, few communities had taken on this effort. In Baltimore, the Great Migration bolstered the strong black organizations already in the city. The local arms of the Urban League and NACW were particularly helpful, and women made up 40% of the Executive Committee.105 Under

Mountain, the Committee could organize long-term partnerships and planning to better support a massive health campaign that reached 34,000 people by 1925.106

Second, whereas most other Weeks concentrated on yards and houses, Mountain targeted public areas. In urban Baltimore, alleys were one of the main places where disease, particularly tuberculosis, was thought to fester. To bring attention to the issue,

Mountain oversaw surveys of these places by Baltimore’s Urban League and other groups.107 The focus on public spaces reinforced the idea that health was a communal activity, and that blame for ill health could not be placed on particular individuals.

104 “Proud Mammas See Infants Take Prizes,” Baltimore Afro-American, April 11, 1924, 1; “43 Organizations in Hospital Drive,” Baltimore Afro-American, May 9, 1925, 13; “Negro Health Week Conference,” November 1, 1926, 11, folder 2, box 1, NNHW, TA.

105 “Many Agencies To Co-Operate Health Week,” Baltimore Afro-American, March 28, 1924, 6; “Health Week Plans Are Now Complete,” Baltimore Afro-American, March 14, 1925, 8.

106 “Outstanding Events in the Year 1925,” Baltimore Afro-American, January 9, 1926, 8; “Baltimore Breaks Health Week Record,” Baltimore Afro-American, August 7, 1926, 11.

107 “Urban League to Study ‘Lung Block’” Baltimore Afro-American, March 7, 1925, 10. White public health organizers also used this strategy of conducting surveys as a way to demonstrate the effectiveness of a public health campaign. See for example Haven Emerson, “A Plan for Promoters,” The Survey 57(4) November 15, 1926: 221. 243

Mountain and the League publicized their findings to get the city’s Health Department involved in promoting the health of African Americans.

Getting the Health Department involved was particularly important. Like Baltimore and other cities, Chicago’s Commission on Race Relations found that “In such matters as rubbish and garbage disposal, as well as street repair, Negro communities were said to be shamefully neglected.”108 The reason for this neglect was racial discrimination. City departments neglected black communities and often refused to provide basic city services. PHS endorsement of NNHW not only encouraged interracial work, but also reinforced efforts of black organizers to get greater support from city agencies. Indeed, according to the historian Samuel Kelton Roberts Jr., “much of Baltimore’s screening and health promotion activity among blacks had centered on the cooperative activities of the expanding network of black and white physicians, civic leaders, and community organizations that had emerged from the National Negro Health Week movement.”109

Third, Baltimore’s NNHW lectures occurred in unusual places. In addition to the more standard spaces, such as local community organizations and churches, Mountain had speakers travel to the industrial plants where blacks worked. Speaking at places of work gave the opportunity for NNHW participation to those who often could not attend meetings on health due to employment obligations. Public health campaigns aimed at whites used this strategy as well.110

108 Roberts, Jr., Infectious Fear, 193; Drake and Cayton, Black Metropolis, 70.

109 Roberts, Jr., Infectious Fear, 214.

110 “Health Week Plans Are Now Complete,” Baltimore Afro-American, March 14, 1925, 8; Henry M. Hyde, “Negroes to get Health Training All Next Week,” Baltimore Sun, March 31, 1925, “THC 1925,” 141, TA. For whites, see for example June Gray, “For Health in Industry,” The 244

Mountain’s NNHW efforts also extended to entertainment. In addition to creating a radio show, she introduced sports as an important part of Baltimore’s campaign. In addition to hosting a basketball game, Baltimore held a running event. The 3.5 mile

“marathon” was the culmination of the Week, showcasing what healthy African

Americans looked like and pitting the healthiest of Baltimore against those from other areas, including Philadelphia and Atlantic City. It even got a celebrity endorsement when

Olympian R. Earl Johnson agreed to send a protégé.111 The race brought greater newspaper coverage of NNHW as those interested in sports now concerned themselves with the Week’s prestigious marathon, thereby exposing them to NNHW ideas about health practices.112

Louisville’s 1925 program incorporated local colleges and the medical establishment.

The University of Louisville’s medical school held lectures specifically for black physicians. Topics ranged from discussions of diseases, such as syphilis and tuberculosis, to ways to encourage people to get periodic exams. This program was unusual for

NNHW in that it involved physicians teaching other physicians instead of laypeople.

Survey 56(2) April 15, 1926: 93-95. NNHW campaigns elsewhere also used this strategy, see for example “Negro Doctors to Talk Today,” Louisville Courier, April 7, 1927, “THC, 1927,” 432, TA.

111 “Health Week Messages and Music Broadcast here,” Baltimore Afro-American, April 11, 1925, 10; “Marathon Race to be Held April 10,” Baltimore Afro-American, March 28, 1925, 7; “Earl Johnson to Enter Tankin in Blatimore Event,” Baltimore Afro-American, April 4, 1925, 7; “Health Week ‘Marathon’,” Baltimore Afro-American, April 11, 1925, 7.

112 The Philadelphia Tribune followed the Baltimore marathon developments closely. See “Frank Mitchell is Fourth in Marathon Race,” Philadelphia Tribune, April 17, 1926, 11; “Eight Storer College Men in Marathon,” Philadelphia Tribune, April 16, 1927, 11; Joseph H. Rainey, “Seen and Heard,” Philadelphia Tribune, May 9, 1929, 10. NNHW campaigns in Springfield, Illinois, Richmond, and Niagara Falls also included races during NNHW, see “Health Week Tests Will be Held Today,” April 6, 1928, “THC, 1928,” 345, TA; “Health Week for Negroes Planned,” Richmond News Leader, March 27, 1930, “THC, 1930,” 521, TA; Joseph H. Rainey, “Seen and Heard,” Philadelphia Tribune, March 27, 1930, 10; “New York State,” Chicago Defender, April 19, 1930, 17. 245

White physicians lecturing black doctors illustrated the medical establishment’s racist perceptions of black doctors. However, NNHW also presented black doctors with an opportunity to engage their peers in interracial work on health, a significant goal of the campaign.113

Indeed urban centers received the bulk of NNHW prizes during the 1920s. Their success was mostly due to their large concentrations of African Americans and more established and widespread health and social welfare agencies. As the Great Migration continued throughout the 1920s, the percentage of African Americans living in urban areas increased from 10% in the early 1900s to 34% in 1930.114 These cities could hold events that reached thousands of people and cleaned whole blocks at a time.

Nevertheless, these were not the places where most blacks lived. As T.M. Campbell of the U.S. Department of Agriculture put it at an NNHW meeting, “We should recognize that there is a great difference between the city health problem and the rural health problem.”115 Although blacks in both areas faced similar issues regarding access to professional medical care and environmental concerns that increased their risk of illness, the ways in which these problems affected them and their solutions were quite different.

Rural work might focus on whitewashing, while time in urban areas might be better spent on organizing large lectures or other public events to promote health.

113 “Getting Ready For Negro Health Week,” Louisville Courier Journal, April 4, 1925, “THC 1925,” 136-137, TA.

114 U.S Bureau of the Census, Statistical Abstract of the United States, 1920 (Washington, D.C.: U.S. Department of Commerce, 1921), 40; U.S Bureau of the Census, Statistical Abstract of the United States, 1935 (Washington, D.C.: U.S. Department of Commerce, 1935), 19.

115 “Conference of Agencies Cooperating in the Promotion of National Negro Health Week,” January 20, 1927, 5, “Annual” folder, box 44, RMLC, TA. 246

Given the attention placed on the cities, some worried that a lack of recognition for the African Americans in the rural South, where the majority of blacks still lived, might cause this group to feel ignored and stop participating in the Week.116 In 1928, in an attempt to encourage greater interest and recognize a wider variety of participation,

NNHW organizers separated awards into community types: cities over 100,000; under

100,000; and rural communities.117

Rural efforts often began with individuals or small organizations writing to the national NNHW organizing committee for bulletins.118 Women were vital here, helping to coordinate activities in the absence of the more well-funded and organized black and white organizations in urban areas. In Maryland’s Anne Arundel County, women made up 60% of the leadership of the award-winning 1929 campaign. Given their scant resources, rural NNHWs could not hold mass lectures, fund health parades, or even sustain a full week. Instead, they concentrated on the basics of the NNHW campaign: painting, cleaning, and destroying breeding places of flies and mosquitoes. These activities constituted the easiest practices to teach and the cheapest ways to improve health. Another element these communities often included was a clinic. Here they attempted to cajole the local health department to assign one doctor or dentist to a

116 “Health Awards to Rural Districts,” Chicago Bee, March 17, 1928, “THC, 1928,” 338, TA.

117 Monroe Work to Albon L. Holsey, December 20, 1927, “Holsey” folder, box 46, RMLC, TA; R. W. Emerson to Albon L. Holsey, December 29, 1927, “R. W. Emerson” folder, box 23, AH, TA; Albon L. Holsey to R.W. Emerson, January 6, 1928, “R.W. Emerson” folder, box 23, AH, TA.

118 See for example: J. S. Jackson Jr., to National Negro Health Week, March 5, 1930, folder 8, box 4, NNHW, TA; Adalyn Hiuchcliffe to National Negro Health League, March 7, 1930, folder 8, box 4, NNHW, TA; M.L. Spigner to the National Negro Health Week Committee, February 19, 1930, folder 8, box 4, NNHW, TA. 247 particular area so that those who had little access to the medical establishment could get care. PHS support for NNHW helped convince many of these departments to support, or even lead the Week, despite the previous discrimination that had contributed to black ill health.119

Overall, NNHW award winners demonstrated a number of similar elements. First, they started organizing early. While Baltimore could organize year-round, Louisville began work on its 1929 program just after the new year and Anne Arundel County started advertising its campaign at the beginning of March. Second, they completed surveys of their communities to either determine the health goals for that year’s NNHW or assess its impact. Third, they stuck to the daily NNHW themes.120 Fourth, women featured in

NNHW leadership. In addition to Mountain, of the winning communities in 1929, two had women in high-ranking positions submit the community’s final NNHW report. In

1930, public health nurse Marjory Forte served as the General Chairman of Kent County

Maryland’s campaign.121 Notably, these women were not all black. Mary Hicks, the white secretary of the Health Council of Louisville, ran that city’s NNHW campaign.122

119 Robert H. Riley, Press Bulletin #268, folder 5, box 4, NNHW, TA. See also “Negro Health Week Is Being Observed Here,” Erie Herald, April 6, 1925, “THC 1925,” 152, TA.

120 See for example “Sixteenth Annual national Negro health Week, March 30-April 6, 1930, as observed in the City of Wichita Falls, Texas,” 2-3, folder 7, box 3, NNHW, TA.

121 “Sixteenth Annual National Negro Health Week, March 30-April 6, 1930, as observed in Kent County, Maryland.” folder 7, box 3, NNHW, TA.

122 Louis R. Lautier, “Business League Takes Three Day Inventory of Commerce,” Chicago Defender, August 24, 1929, 3. 248

Fifth, they incorporated, and cooperated with, local health departments and associations.123

Taking a similar perspective to NNHW judges a decade earlier, 1929 judge Elmer A.

Carter explained that the measure of an NNHW campaign was not the number of lectures given or yards cleaned. Instead, it was the campaign’s ability to bring “to bear upon

Negro health the influence and the cooperation of the bona fide health agencies in the community for a permanent program of disease prevention and health conservation.”124

More specifically, Carter focused on “the extent to which the effort was being made as a community effort rather than a Negro effort.”125 It did not matter that Anne Arundel’s

NNHW clinics only saw 60 children and their mothers while Louisville’s had over 100 children examined.126 What mattered was the effort, ideally interracial, to combine as many resources as possible to support African American health improvement not for a week, but throughout the year. Hence, Nashville’s 1930 program stood out as the city got

207 organizations to participate, received more white press coverage than black, and created a year-round NNHW committee.127

123 “National Negro Health Week: Sixteenth Annual Observance {1930}, Sunday, Mary 30, to Sunday, April 6,” PHS, Washington, D.C., 1930, 3-7, folder 3, box 1, NNHW, TA.

124 Elmer A. Carter to Albon Holsey, July 10, 1929, folder “Health Week 1929,” box 16, AH, TA.

125 Elmer A. Carter to Albon Holsey, July 10, 1929, folder “Health Week 1929,” box 16, AH, TA.

126 “Health Week Campaign in Anne Arundel County,” 1-2, folder 5, box 4, NNHW, TA; “Report on Negro Health Week: March 31 – April 7, 1929, Louisville, Kentucky,” Negro health Week Committee of the Health Council Cooperating with the Kentucky Inter-Racial Commission, March 31 – April 7, 1929, 1-8, folder “Health Week Reports,” box 16, AH, TA.

127 “True copy of summary of report of the Sixteenth Annual National Negro Health Week, as observed in Nashville, Tennessee, March 30-April 6, 1930,” folder 7, box 3, NNHW, TA. As a 249

Physician Leadership in the Week’s Campaigns, 1920-1926

Throughout the 1920s, the NMA struggled with its role in NNHW even as it acknowledged NNHW “as one of the most important national movements among our people, and predict that much greater results will be evident in the next five or six years.”128 Its leadership remained upset with NMA’s inability to gain more traction in directing NNHW. While the involvement of the PHS gave NNHW greater publicity and resources, which had the potential to increase the perceived value of doctors through

NNHW bulletins and lectures, it also meant that white medical leaders now had a large voice in NNHW activities. The participation of the NTA, the American Child Hygiene

Association, and others limited the impact the NMA could have on NNHW’s agenda.

This situation was particularly difficult for the NMA considering that African Americans who had no health credentials ran NNHW, a campaign to improve African American health. Moton and Work still organized the Week out of Tuskegee. That it had to fight just to get a seat at the NNHW table galled the NMA.

The NMA wanted black physicians to lead NNHW because the group felt that black medical professionals had a better understanding of the folkways and health needs of

African Americans. In Pennsylvania, this aspiration became a reality when Dr. George

W. Bowles, vice-president of the NMA, organized a partnership with the state health point of comparison, Baltimore’s 1924 campaign had 22 participating organizations and Chicago’s 1928 and 1929 campaign’s had 37. See “Many Agencies To Co-Operate Health Week,” Baltimore Afro-American, March 28, 1924, 6; “Emphasize Tuberculosis in Fourth ‘Health Week,’” Chicago Defender, April 14, 1928, 10; William D. Giles and S. D. Hamilton, “Section I - The Organization and Set Up of the 1929 Health Campaign Committee,” n/d, 1-12, folder 19, box 2, NNHW, TA.

128 “National Negro Health Week,” JNMA 18(2) 1926: 83-84, 84. See also “Mortality from TB 1921,” JNMA 15(1) 1923: 46-48, 47; “National Negro Health Week, JNMA, 22(1) 1930: 37. 250 department.129 Some perceived Bowles’ effort, in the context of the PHS endorsement, as the beginning of a permanent change in NNHW leadership. The Philadelphia Advocate reported that “a movement will now be launched to have every state in the Union get authorization to have physicians direct the celebration of National Negro Health week[sic].”130

The 1923 NNHW in Pennsylvania was different from those in other states. First, the

Week’s primary activities were lectures and the vast majority of speakers were physicians. This promotion of the medical establishment was a common practice when doctors organized the Week. Second, and more importantly, these speeches had a greater focus on medical practices, rather than individual health practices that average African

Americans could implement.131 This agenda could prevent physicians from connecting with their audience. When Dr. Wilmer Krusen spoke at Lancaster’s NNHW, he defended establishment medical practices, such as quarantines during outbreaks and compulsory

129 “Dr. Bowles Has state Health Department Take Over Negro Health Week,” Philadelphia Advocate, May 6, 1922, “THC 1922,” 670, TA. Susan Smith noted the NMA’s interest in controlling NNHW as well. See Smith, Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890-1950 (Philadelphia, PA: University of Pennsylvania, 1995), 62-64.

130 “Dr. Bowles Has state Health Department Take Over Negro Health Week,” Philadelphia Advocate, May 6, 1922, “THC 1922, ” 670, TA.

131 “Negro Health Week Begins April 1st,” Pittsburgh American, March 30, 1923, “THC 1923,” 773, TA; “Plan Health Week Here Next Month,” Lancaster New Era, March 10, 1923, “THC 1923,” 773, TA; “Program for Health Week,” Lancaster New Era, March 15, 1923, “THC 1923,” 774, TA; “Drs. Wright and R. O. Miller Spoke at Community Center,” Erie Times, April 13, 1923, “THC 1923,” 774, TA; “Negro Health Week Helped by Furbush,” Philadelphia North American, April 2, 1923, “THC 1923,” 774, TA; “Health Topics Are Discussed,” Lancaster New Era, April 3, 1923, “THC 1923,” 774, TA; “Negro Health Week is Observed Here,” Scranton Republican, April 2, 1923, “THC 1923,” 774, TA; “Dr. Krusen Is Speaker Here,” Lancaster New Era, April 6, 1923, “THC 1923,” 775, TA; “Lauds Workers in Health Plan,” Lancaster New Era, April 12, 1923, “THC 1923,” 775, TA. This was true of Chicago too, although to a lesser degree, see for example “Emphasize Tuberculosis in Fourth ‘Health Week,’” Chicago Defender, April 14, 1928, 10. 251 vaccinations.132 These issues had been significant contributors to the general African

American mistrust of physicians. Their defense was unlikely to decrease black trepidation of the medical establishment and even black physicians, directly countering the benefits

G. N. Woodward envisioned for physicians participating in NNHW.

Elsewhere, some physicians misdirected their efforts to inculcate “proper” health practices. Ralph Matthews of the Baltimore Afro-American noted that much of the advice

African Americans received involved “telling you to eat a lot of things you can’t afford to buy.”133 As Krusen illustrated, Matthews asserted that doctors did not understand to whom they spoke. Given their limited incomes, most African American diets lacked variety which made them susceptible to pellagra and other diseases.134 Such advice went against the core of NNHW: to provide easy to apply practices that would improve black health.

However, Bowles’ work in Pennsylvania did not lead to physician control of NNHW.

It did not even create a radical shift in NNHW policy. At the NMA’s annual convention in 1925, president Michael O. Dumas echoed Booker T. Washington in asserting that the

“Physical well-being of the Negro means economic well-being, for industry demands strong workmen. And economic well-being means social advancement – better homes,

132 “Dr. Krusen Is Speaker Here,” Lancaster New Era, April 6, 1923, “THC 1923,” 775, TA. In 1923, Philadelphia’s health department used quarantining instead of vaccination to save money, see McBride, Integrating the City of Medicine, 61-62.

133 Ralph Matthews, “Hear and Seen In Baltimore,” Baltimore Afro-American, April 18, 1925, 18.

134 Newbell N. Puckett, Folk Beliefs of the Southern Negro (Chapel Hill, NC: The University of North Carolina Press, 1926), 372; Farley, Growth of the Black Population, 11, 71-73. 252 cleaner habits, freer minds.”135 Like NNHW’s leaders, Dumas perceived health as the building block upon which African Americans could improve their status in society.

To that end, in 1925, the NMA published a 12-step guide to preserving health. The guide reflected an acceptance of NNHW’s focus on simple and cheap health practices as the best way to improve black health. Advice such as, “Bathe often. Wash your hands before eating” allowed readers to practice good health on their own. While explanation of disease was simplistic, “Disease germs love darkness rather than light because their deeds are evil,” it reinforced the basic concepts of sunlight and fresh air that fought TB.

However, the guide did encourage seeing physicians and dentists annually, which most

African Americans could not do given the racism of white medical professionals and the location of most physicians in cities. It also advised against the use of folk medicine, often one of the few avenues open to blacks who were ill. These final pieces supporting the use of medical professionals illustrated the continued differences between the Week’s leaders and their medical professional counterparts regarding the Week’s goals and target audience.136

In addition to the NMA’s concerns about leadership, physicians, both black and white, worried about the content and direction of the Week. Although Cumming supported the Week, according to the Savannah Journal, the Surgeon General also thought that public health education programs should focus on “the prevalence and

135 “Medical Men Meet In Chi,” Baltimore Afro-American, August 29, 1925, A13.

136 “Health and Welfare,” Savannah Tribune, April 9, 1925, “THC 1925,” 132, TA. The NMA advice was reprinted verbatim in the 1927 bulletin. See “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, back cover, folder 1032, box 132, RMGC, TA. The 1926 bulletin contained similar concepts, see “National Negro Health Week: April 4 to 10, 1926,” PHS, Washington, D.C., 1926, back cover, T27.2: N31 926, box T702, “Publications of the Federal Government,” RG 287, NARA II. 253 prevention of venereal and other diseases.”137 Like the NMA, Cumming asserted that a medical focus for NNHW would bring better results. The battle between a focus on the medical professional, vaccination, immunization, and specific disease education on one side, and the formalization of health practices the public could implement on the other side, would continue into the late 1920s. Wrapped up in this debate was the question over the role of individual health practices as a way for blacks to empower themselves and challenge white racist beliefs and practices.

National Planning and the Late 1920s

The planning meeting for the 1927 Week illustrated the variety of perspectives within the health community. Eighteen people representing 14 groups attended the Washington,

D.C. planning meeting in November of 1926. Although Tuskegee directed the Week,

NNHW partners worked together at these annual planning meetings at PHS headquarters to organize the year’s health priorities and discuss other NNHW topics, such as the design of the bulletin. This location had the added benefit of being easily accessible to the many groups participating in NNHW, including the NTA, NMA, NNBL, American Red

Cross, American Child Health Association, National Organization of Public Health

Nursing, and Howard University.

While all attendees agreed on the value of the Week, questions remained about who should lead it and what kinds of health concepts and messages to use. In addition to the

PHS, the partnering organizations wanted their voices heard in NNHW and asked that the

137 “Negro Health Week Pronounced a Success,” Savannah Journal, April 25, 1925, “THC 1925,” 119, TA. 254 bulletin include their health materials and ideas.138 Many of these organizations were either led by medical establishment personnel, or had physicians in positions of authority within their groups. Thus, this situation allowed the medical establishment to have a greater say about the development and distribution of NNHW literature.

The medical establishment’s efforts here were not unique to African Americans.

Throughout the medical profession, worries that people did not trust their doctors made medical professionals feel that they alone were the best source of health information. As

The Survey explained, “It is perfectly obvious that these people [poor people looking for health education] can be helped only by direct contact with competent medical service.”139 In this context, it was up to the National Organization for Public Health

Nursing to approve the literature for the American Child Health Association’s “Child

Health Day” campaign.140 Throughout this period, medical professionals began to take a more active role in teaching personal hygiene and participating in health education, and

NNHW reflected these interests.

The effort to seize greater control from Tuskegee’s non-medical leaders gained more traction when the meeting’s participants created the National Negro Health Week

Committee (NNHWC). The Committee’s purpose was to take all of the health data, brochures, and ideas of the Week’s partners and incorporate them into the bulletin to provide direction and goals for the Week. The NNHWC consisted of Monroe Work,

Algernon Jackson, a doctor and professor at Howard University, Roscoe Brown, James

138 “Negro Health Week Conference,” November 1, 1926, 9, folder 2, box 1, NNHW, TA.

139 Donald B. Armstrong, “See Your Doctor,” The Survey 58(7) July 1, 1927: 386-388 & 393-397, 388.

140 “May Day” The Survey 57(10) February 15, 1927: 636. 255

Bond of Kentucky’s Commission on Interracial Cooperation, and R. Maurice Moss, executive director of Baltimore’s Urban League.141 All were African American because, as Draper explained, “We [the PHS] should not originate the bulletin. We will aid in its preparation and distribution, but the material should come from the people…who are capable of vitalizing it, especially for the class of people we want it to reach.”142 While this language indicated a certain amount of empowerment and opportunity for African

Americans to lead in health, it also implied the segregationist tendencies rampant in the government. Blacks would focus on black issues, whites on white issues.

The members of the NNHWC fit into two categories. R. Maurice Moss and James

Bond were community organizers. Bond had great success organizing Kentucky’s statewide NNHW campaigns, while R. Maurice Moss had worked with Elsie Mountain to grow Baltimore’s award-winning program. Both had an understanding of grassroots organizing and how to cooperate with whites. On the other hand, Roscoe Brown and

Algernon Jackson were the medical professionals. Brown, a dentist and Chairman of the

Committee, had worked with the PHS, understood its methodology, and could effectively wield its resources. Jackson, a physician, had experience with patients and was familiar with African American health issues. As representatives of the medical establishment, they supported the work of medical professionals. In the middle, was Monroe Work, the

141 “Negro Health Week Conference, Afternoon Session,” November 1, 1926, 1, 11, folder 2, box 1, NNHW, TA. “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, ii, folder 1032, box 132, Robert Moton General Correspondence (RMGC), TA.

142 “Negro Health Week Conference,” November 1, 1926, 10-11, folder 2, box 1, NNHW, TA. 256

Committee’s Secretary and the original organizer of the Week and bulletin.143 Given his role as the original founder of NNHW, he was reluctant to deviate from the core ideas of the campaign. That Moton was not chosen for the Committee was not a slight. Indeed he could have nominated himself, but Work’s nomination and Moton’s responsibilities to

Tuskegee made his service unnecessary. However, Moton continued to serve as an important voice and influence on the Week as it continued to operate out of Tuskegee.

Before the NNHWC could create the bulletin, those at the planning meeting had to decide on the bulletin’s target audience: the lay public or community leaders. Work had originally intended the bulletin for ordinary African Americans.144 The idea was to make the bulletin as easy to follow as possible because in some communities, as Work explained, “There may be no other sources [of health information].”145 Work, along with

Brown, Draper, T. M. Campbell of the U.S. Department of Agriculture, and Lucy Oppen of the American Child Health Association, argued that common people and leaders required different information. While lay men and women needed basic rules of health, leaders needed to know the steps to take in order to create a Week in their locale. Work had constructed the first Bulletin so that anyone picking up a copy had access to some health practices and information that he or she could incorporate into daily life. However, using the bulletin in this way made NNHW participants reliant on it for health information, requiring many copies.

143 “In Memoriam: Dr. Monroe N. Work, Tuskegee Institute, Ala.,” National Negro Health News (NNHN) 13( 2) 1945: 24.

144 “Negro Health Week Conference,” November 1, 1926, 8, folder 2, box 1, NNHW, TA.

145 “Negro Health Week Conference,” November 1, 1926, 4, folder 2, box 1, NNHW, TA. 257

A bulletin exclusively for leaders required the production of far fewer since it would be up to community leaders, not the bulletin, to disseminate health information into their communities.146 These leader-focused bulletins required greater detail and complexity because they needed to identify specific ways to organize the community. More explanation meant less room for detailed discussions of health practices individuals could use to improve their health. Thus, local leaders began to turn more toward medical professionals to help them organize and lead NNHW.

Late 1920s Bulletins

Within the context of keeping costs low, increasing turnout, and the migration of blacks to dense urban areas that supported a larger campaign, the NNHWC decided that the bulletin would target “community leaders in an effort to suggest ways…individuals and organizations may be organized for a concerted and effective attack upon the community’s disease problems.”147 Much of the advice was similar to that of the late

1910s, but with greater detail. According to the Committee, having local groups create committees on specific aspects of the Week, such as publicity, speakers, and each day’s theme, had to do with more than just good organization.148 The NNHWC thought local

146 “Negro Health Week Conference,” November 1, 1926, 7-10, folder 2, box 1, NNHW, TA.

147 “National Negro Health Week: April 4 to 10, 1926,” PHS, Washington, D.C., 1926, 2, T27.2: N31 926, box T702, “Publications of the Federal Government,” Record Group (RG) 287, NARA II; “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, iii, folder 1032, Box 132, RMGC, TA. This decision to target community leaders was tried in 1926, but not formally decided until the planning meeting. Indeed many of the items the NNHWC would agree to implement began in 1926 but were not established as permanent until the NNHWC’s creation.

258 leaders would have greater success enticing support if they could offer a committee position. The more committees, the more positions available and the more comprehensive community buy-in.

The NNHWC tried a few new strategies to encourage greater organization and participation. In 1926 they introduced annual themes to build greater continuity across the Weeks. At the beginning, these themes were fairly general: “More Negro Health

Work” (1926); “Negro Health, Our 1927 Challenge” (1927); and “Concentrated Attack on the Negro Health Hazards in Every Community” (1928).149 All these supported the overall concept of health, but permitted wide latitude as to what constituted proper health.

Each community could identify what “more negro health work” looked like, or where to concentrate efforts against hazards to African American health. These themes emphasized ease of participation and grassroots community action. The 1929 and 1930 themes: “A Complete Health Examination for Everybody,” and “More Regular Use of

Existing Health Services,” illustrated the growing medical professional interest in leading

NNHW.150

A new element the NNHWC introduced in the bulletin was the use of images. The

1927 bulletin featured several images, the most attention-grabbing of which was on the

148 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, 2-3, folder 1032, box 132, RMGC, TA. By comparison, the 1926 bulletin suggested two committees. See “National Negro Health Week: April 4 to 10, 1926,” PHS, Washington, D.C., 1926, 3, T27.2: N31 926, box T702, “Publications of the Federal Government,” RG 287, NARA II.

149 Brown, “The National Negro Health Week Movement,” 557.

150 “National Negro Health Week: Sixteenth Annual Observance {1930}, Sunday, Mary 30, to Sunday, April 6,” PHS, Washington, D.C., 1930, cover, folder 3, b, NNHW, TA; “National Negro Health Week: Sixteenth Annual Observance {1930}, Sunday, Mary 30, to Sunday, April 6,” folder 11, box 1, NNHW, TA. 259 front cover. A cute, smiling baby in a tub greeted those who picked up the bulletin.151

Inside, readers found two images of what “proper” health care might look like. Both focused on the role of women. One portrayed a mother and two daughters with the caption: “Contented home life promotes both individual and community health.”152 While not depicting a particular health practice, the family appears clean and well cared for, as does the home, which is spotless and well lit. The other showed a mother preparing to breast feed her child. The bulletin noted that this Figure 1 basic health practice was “The most living act a mother can do,” and explained that “When [a] baby nurses it not only gets the best food, but is less liable to many diseases.”153

In addition to their eye-catching nature, the

NNHW Committee used images of African

Americans because, as The Survey explained,

“Practically all the pictures Negro children see are white.” This situation had the potential to give blacks “the notion, unconsciously, that the 1927 NNHW Bulletin Cover

151 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, cover, folder 1032, box 132, RMGC, TA.

152 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, opposite page 3, folder 1032, box 132, RMGC, TA. The 1930 bulletin contained a similar picture of a clean family, see “National Negro Health Week: Sixteenth Annual Observance {1930}, Sunday, Mary 30, to Sunday, April 6,” PHS, Washington, D.C., 1930, cover, folder 3, box 1, NNHW, TA.

153 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, 11 and opposite page 11, folder 1032, box 132, RMGC, TA. Quotes are from page 11. 260 white child only has a chance to be good or heroic or beautiful.”154 The Louisville Post argued that displaying images of African Americans made “a direct and personal appeal to the negro,” which would stimulate participation in NNHW.155 Showing images of

African Americans made health instruction concrete and clear, and reinforced the idea that African Americans could obtain “proper” health. PHS officials thought there was so much power in images that they agreed to produce a poster to go along with the bulletin.156

To support the 1929 theme “A Complete Health Examination for Everybody,” the

NNHW Committee selected images of upper-class African Americans demonstrating their health. The Figure 2 Figure 3 bulletin’s cover displayed a man and a woman ready to play tennis. The implicit message was that these people had inculcated and ritualized health practices that allowed 1929 NNHW Poster 1929 NNHW Bulletin Cover

154 “Reaching the Negro,” The Survey, September 8, 1920, “THC 1920,” 545, TA.

155 “Negro Health Week is Widely Observed,” Louisville Herald, April 3, 1922, ““THC 1922,” 682, TA.

156 Brown, “The National Negro Health Week Movement,” 558; McBride, From TB to AIDS, 108. The PHS began producing posters in 1927. 261 them to participate in sports, and they had seen their physicians.157 This cover matched the poster for that year, which featured a woman catching a ball with the caption “Are

YOU Physically Fit?”158 Showing African Americans participating in the same kinds of healthy activities as whites reinforced the concept that they could have the same health outcomes. Yet the health theme for 1929 indicated that African Americans could only achieve “proper” health if they followed medical establishment advice.

In addition to photographs and annual themes, the Week’s daily themes also changed to promote more effective organization. The NNHWC replaced the days dedicated to swatting flies, tuberculosis, and church sanitation, with “Adults’ Health Day,” a

“Community Sanitation Day,” and a “Special Campaign Day,” to facilitate greater local flexibility.159 Of course, one of the major diseases flies and other pests spread was tuberculosis, which was especially widespread in urban black communities such as

Baltimore, Washington, D.C. and Philadelphia. These were places where a large number of poor blacks and migrants lived. Their susceptibility to diseases particularly concerned whites. Numerous black washerwomen resided in dirty, poorly ventilated alleys where

157 “National Negro Health Week: Fifteenth Annual Observance (1929), Sunday, March 31, to Sunday, April 7,” PHS, Washington, D.C., 1929, front cover, folder 21, box 2, NNHW, TA.

158 “National Negro Health Week: Fifteenth Annual Observance, Sunday, March 31, to Sunday, April 7,” 1929, folder 3, box 2, NNHW, TA.

159 “National Negro Health Week: April 4 to 10, 1926,” PHS, Washington, D.C., 1926, ii, T27.2: N31 926, box T702, “Publications of the Federal Government,” RG 287, NARA II; “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, inside cover, folder 1032, Box 132, RMGC, TA; “National Negro Health Week: April 1 to 8, 1928,” PHS, Washington, D.C., 1928, inside cover, T27.2:N31/928, Ohio University Library, Athens, Ohio (OUL); “National Negro Health Week: Fifteenth Annual Observance (1929), Sunday, March 31, to Sunday, April 7,” PHS, Washington, D.C., 1929, inside cover, folder 21, box 2, NNHW, TA; “National Negro Health Week: Sixteenth Annual Observance {1930}, Sunday, Mary 30, to Sunday, April 6,” PHS, Washington, D.C., 1930, inside cover, folder 3, box 1, NNHW, TA. After 1925, “Sermon and Lecture Day” became “Mobilization Day,” but had the same goals. After 1928, “Home Hygiene Day” became “Home Health Day” and “Child health Day” became “School Health Day,” but the advice on how to support those days remained unchanged. 262 they washed and ironed clothing, sheets, and other bedding for white people. In the early twentieth century, cities such as Baltimore, Philadelphia, New York City, Boston,

Cincinnati, and Omaha that had numerous alleys were especially hard hit.160 The “Special

Campaign Day” gave local leaders an opportunity to focus on health concerns particular to their community. Here the NNHWC embraced what some communities already did, encouraging widespread efforts to target local health issues.

The bulletin’s description of how to support the themes of each day included a few notable changes. In addition to the standard sermons in churches from the clergy and guest speakers on “Mobilization Day,” the bulletin advised holding a mass meeting that night. According to Jackson, the goal of this evening event was to “find some way to make health the fashionable thing.”161 To generate not just awareness, but enthusiasm for the Week, the NNHWC suggested including music and entertainment as part of the mass meeting.162 While most events included speakers, the bulletin advised them to “give short, pithy addresses on the subject of the day.”163 The idea was to generate interest and excitement, not boredom. A few direct talking points were enough to scratch the surface

160 The Baltimore Afro American ran a number of stories on problems with alleys. See for example “Urban League to Study ‘Lung Block’” Baltimore Afro-American, March 7, 1925, 10. The Southern Workman also had many stories on this issue. See for example Edith Elmer Wood, “The Negro Alleys of Washington,” Southern Workman 43(6) June 1914: 350-358; Esther Fletcerh Brown, “Sanitary Housing in Washington, D.C.,” Southern Workman 44(11) November 1915: 590-597; “Housing in Southern Cities,” Southern Workman 44(7) July 1915: 371-372. See also Frederick Weller, Neglected Neighbors: Stories of Life in the Alleys, Tenements, and Shanties of the national Capital (Philadelphia, PA: Winston, 1909), 20-26; Roberts, Jr., Infectious Fear, 107-138; Hampton Magazine 13(1) April 1904: 103.

161 “Negro Health Week Conference,” November 1, 1926, 10, folder 2, box 1, NNHW, TA.

162 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, 4, folder 1032, box 132, RMGC, TA.

163 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, 3, folder 1032, box 132, RMGC, TA. 263 of NNHW ideas. The music and entertainment for the evening would make the Week the popular and stylish thing to do and increase participation from those on the fence.

“Home Hygiene Day” still concentrated on the health of the family, but it now included the suggestion that men go to meetings on venereal disease and “the responsibility of fathers.”164 This emphasis on venereal disease suggested the continuation of the medical establishment’s racist beliefs about black sexual promiscuity.

“Adults’ Health Day” was for general adult health checks and clinics, and getting young and expectant mothers to go to see physicians.165

One notable difference between the bulletins of the late 1920s and the original in

1915 was the decrease in discussing specific health practices. The advice included in the late 1920s bulletins discussed the need to remove tin cans “in which mosquitoes breed.”

They gave the same reason for cutting weeds and removing garbage. As opposed to the

1915 Bulletin’s detailed advice on sanitary privy creation, those of the late 1920s just stated that communities should discus “The planning, location, and sanitation of privies.”166 Such generality was not due to a lack of space since the late 1920s bulletins were often more than 20 pages. Instead, it signaled the changing demographics of the

NNHW movement, specifically its appeal to the urban migrants who had different

164 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, 4-5, folder 1032, box 132, RMGC, TA.

165 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, 7, folder 1032, box 132, RMGC, TA; “National Negro Health Week: April 4 to 10, 1926,” PHS, Washington, D.C., 1926, 7, T27.2: N31 926, box T702, “Publications of the Federal Government,” RG 287, NARA II.

166 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, 5, folder 1032, box 132, RMGC, TA; “National Negro Health Week: April 1 to 8, 1928,” PHS, Washington, D.C., 1928, 5, T27.2:N31/928, Ohio University Library, Athens, Ohio (OUL); “National Negro Health Week: Fifteenth Annual Observance (1929), Sunday, March 31, to Sunday, April 7,” PHS, Washington, D.C., 1929, 5, folder 21, box 2, NNHW, TA. 264 concerns than privy usage. Activities and actions that individuals could take to improve health remained an important part of NNHW, but the bulletin’s decrease in explaining

“proper” health practices encouraged medical professionals to step into this void.

The Special Campaign Day was of particular interest to the NNHW Committee. To create an effective Day, the Committee suggested conducting health surveys to assess the needs of the community and target “some special disease menace.”167 This use of a survey was a strategy that white public health organizers used as well.168 Communities targeted a variety of health concerns during this Day, ranging from basic hygiene to vaccinations and access to medical professionals.169 However, the bulletin’s notation of a

“disease menace” indicated an emphasis on medical professional intervention, not lay health practices. The example the bulletin provided was to fight TB by using the Week to raise money to employ a public health nurse.170 As many communities, black and white,

167 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, 7, folder 1032, box 132, RMGC, TA; “National Negro Health Week: April 4 to 10, 1926,” PHS, Washington, D.C., 1926, 7, T27.2: N31 926, box T702, “Publications of the Federal Government,” RG 287, NARA II.

168 Haven Emerson, “A Plan for Promoters,” The Survey 57(4) November 15, 1926: 221.

169 “Health Week to be Observed Here,” Nashville Globe, March 19, 1926, “THC, 1926,” 855, TA; “Health Week Held by Negroes,” Louisville Courier, April 4, 1927, “THC, 1927,” 431, TA; “Negro Health Week,” Macon Telegraph, March 1, 1927, “THC, 1927,” 421, TA; “Health Week For Negroes Planned,” Birmingham News, March 31, 1929, “THC, 1929,” 157; “Negro Health Week Dates Are Set For Observance Here,” Springfield Register, March 16, 1930, “THC, 1930,” 486, TA; “Negro Health Week,” Middletown Times-Herald, March 31, 1930, “THC, 1930,” 507, TA; C. E. H. Daniel, “The Institute and Negro Health,” St. Mary’s Beacon, April 4, 1930, “THC, 1930,” 497, TA; “Stewed Caterpillars Warned Against,” Baltimore Afro-American, March 2, 1929, 17; “To the Leaders of the Colored Communities of LaSalle Parish,” February 22, 1929, folder 2, box 2, National Negro Health Week, TA.

170 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, 8, folder 1032, box 132, RMGC, TA; “National Negro Health Week: April 4 to 10, 1926,” PHS, Washington, D.C., 1926, 7, T27.2: N31 926, box T702, “Publications of the Federal Government,” RG 287, NARA II. Such an example may have been based on a real effort during NNHW, such as the one made in Galveston, Texas, see “Negro Public Health Week is Inaugurated Here Today,” 265 had demonstrated, there were a variety of ways to fight tuberculosis that included cleaning up alleys and other dirty areas, as well as promoting ventilation and screens in homes. Yet the NNHWC focused on what a medical professional, not a lay person, could do to combat tuberculosis. The NNHWC suggested using this day's target as the focus of a community’s year-round health campaign, thereby encouraging communities to have medical professionals lead their year-round health work.

Perhaps the biggest alteration to the campaign was the addition of the “Report and

Follow-up Day,” whereby NNHW now spanned from one Sunday to the next. The

NNHWC designed this last Day for two purposes. The first was to better track NNHW participation and encourage more local committees to send reports back to Tuskegee.

Few local NNHW committees responded to Tuskegee’s requests to send in reports on their work. In 1923 Tuskegee received just 45 reports, only nine of which included the number of participants.171 A host of factors played into this lack of information, but the

NNHWC thought the biggest obstacles were that organizers did not make it a priority and that they did not know what to include.

To help solve this problem, the 1928 bulletin included a form to track NNHW activity for local organizers to send back to the NNHWC. Using categories, such as “Cleaned,”

“Painted and Decorated,” and “Planted,” leaders could count the numbers of yards and homes cleaned, vegetable gardens created, and piles of trash removed. These were all

Galveston News April 4, 1920, “THC, 1920,” 553, TA; “Addresses Feature Opening Day of Negro Health Week,” Galveston News April 5, 1920, “THC, 1920,” 553, TA.

171 National Negro Health Week, April 1 to 7, 1923, The Ninth Annual Observance (Washington, D. C.: Government Printing Office, 1923), iii, T27.2:N31 923, Box T702, “Publications of the Federal Government,” RG 287, NARA II. In Texas, F. Rivers Barnwell had similar experience in 1926. See “Conference of Agencies Cooperating in the Promotion of National Negro Health Week,” January 20, 1927, 6, “Annual” folder, box 44, RMLC, TA. 266 activities that lay people could easily and cheaply accomplish. However, unlike the 1915

Bulletin and even those of the early 1920s, it did not include an explanation of how these activities would improve health. The form was a tool for counting and tracking participation, not teaching health education. Later versions included a section for counting the numbers of lectures, movies, newspaper articles, pieces of health literature, clinics, and health demonstrations.172

In addition to providing the NNHWC with detail about the Week’s accomplishments, the categories in the activities form gave new leaders a checklist of specific activities to implement during their NNHW program. These reports could even serve as a concrete guide to organizing the campaign. To decrease the bulletin’s size, the NNHWC’s 1930 bulletin published the reports of the 1929 prize winners instead of a detailed description of what to do each day. Communities could then match their work to that of the previous year’s prize winner in their particular type of community to see exactly what a successful campaign looked like.173

NNHW Year-Round

The second purpose of the Report and Follow-up Day was to promote the year-round component of NNHW. Up to this point, NNHW’s year-round program had consisted of a list of 17 to 18 health rules that readers cut out of the bulletin and placed in their homes.

172 “National Negro Health Week: April 1 to 8, 1928,” PHS, Washington, D.C., 1928, 25, T27.2:N31/928, OUL; “National Negro Health Week: Fifteenth Annual Observance (1929), Sunday, March 31, to Sunday, April 7,” PHS, Washington, D.C., 1929, VI, folder 21, box 2, NNHW, TA; “National Negro Health Week: Sixteenth Annual Observance {1930}, Sunday, Mary 30, to Sunday, April 6,” PHS, Washington, D.C., 1930, VI, folder 3, box 1, NNHW, TA.

173 “National Negro Health Week: Sixteenth Annual Observance {1930}, Sunday, Mary 30, to Sunday, April 6,” PHS, Washington, D.C., 1930, 3-7, folder 3, box 1, NNHW, TA. 267

The rules stressed general actions individuals could take to improve health, such as fresh air, proper diet, clean hands and mouth, and using a handkerchief to cover the mouth or nose when coughing or sneezing.174 These were all practical suggestions for people living with little means, and met the basic criteria of year-round health work. However, the

NNHWC envisioned a more obvious and expansive year-round effort.

Yet there was little agreement from the Committee about exactly what that year- round effort should look like. One suggestion was to have NNHW align its year-round health push with one for whites. Lucy Oppen of the American Child Health Association suggested connecting NNHW with the Association’s May Day Program. This partnership would support NNHW’s interracial goals for health work and create a year-round health movement for all Americans.175 However, the Association would ostensibly lead such a movement, transitioning NNHW out of the control of African Americans.

Another suggestion was to hold a national conference during NNHW to create a nation-wide year-round health topic. According to Algernon Jackson, “We [African

Americans] do get advertised badly because of our health condition.”176 As Jackson explained, this national conference would act as a gigantic signal that African Americans

174 National Negro Health Week, April 1 to 7, 1923, The Ninth Annual Observance (Washington, D. C.: Government Printing Office, 1923), folder 660, box 89, RMGC, TA; National Negro Health Week, March 30 to April 5, 1924, The Tenth Annual Observance (Washington, D. C.: Government Printing Office, 1925), 12, T 27.2: N31 924, box T702, “Publications of the Federal Government,” RG 287, NARA II; National Negro Health Week, April 5 to 11, 1925, The Eleventh Annual Observance (Washington, D. C.: Government Printing Office, 1925), back cover, folder 1032, box 132, RMGC, TA. “National Negro Health Week: April 4 to 10, 1926,” PHS, Washington, D.C., 1926, back cover, T27.2: N31 926, box T702, “Publications of the Federal Government,” RG 287, NARA II. These steps were very similar to the NMA’s 12 step guide, see “Health and Welfare,” Savannah Tribune, April 9, 1925, “THC 1925,” 132, TA.

175 “Negro Health Week Conference,” November 1, 1926, 11, folder 2, box 1, NNHW, TA.

176 “Negro Health Week Conference,” November 1, 1926, 12, folder 2, box 1, NNHW, TA. 268 understood proper health, which would “set up the idea that he [the African American] is making a better American citizen. It is a hard thing for a negro to let the world know he is an American citizen, a negro, and a Christian at the same time.”177 Jackson hoped that the publicity this conference generated would demonstrate to whites that they shared the same health concerns and used the same strategies to combat ill health as blacks. Ideally, this understanding would lead to a decrease in the discriminatory practices that African

Americans faced on a regular basis.

Alternatively, Dr. John Ferrell of the International Health Board suggested NNHW committees work year-round to support the hiring of public health workers. These health professionals would provide NNHW with a permanent group to oversee NNHW committees throughout the year, and allow for better year-by-year tracking of local health progress.178 These professionals would also be experts in health education, the campaign’s main point of emphasis. As Brown explained, “I do not believe there is anybody who does not know that air, sunshine, food, exercise, and prevention of infectious diseases are the way to longevity, but they do not know how to put it over.”179

The problem for NNHW organizers was how to internalize proper health practices in others, an area in which public health workers were experts. Furthermore, having more public health workers would provide another voice to help make African Americans more comfortable interacting with health officials.

177 “Negro Health Week Conference,” November 1, 1926, 13, folder 2, box 1, NNHW, TA.

178 “Negro Health Week Conference,” November 1, 1926, 13-14, folder 2, box 1, NNHW, TA. While unstated, Ferrell seems to have assumed that these workers would be African American as he compared his description of these public health workers with that of white public health workers.

179 “Negro Health Week Conference,” November 1, 1926, 14, folder 2, box 1, NNHW, TA. 269

While the types of public health workers varied, Gertrude Bowling of the National

Organization of Public Health Nursing thought her organization best poised to support this year-round effort.180 Even though African Americans made up less than 3% of all trained nurses, Bowling proposed that public health nurses, regardless of color, take on a more prominent role in NNHW.181 According to Bowling, in addition to their training in health education instruction, the house calls public health nurses made put them in a position to provide needed publicity for NNHW. Their travels also let them assess a community’s health needs to prepare for the Special Campaign Day. Finally, in addition to the trust these nurses built in caring for and visiting their patients regularly, they often had to work with other public health groups, giving them valuable experience in health organizing.182 For all these reasons, Bowling thought public health nurses should be at the forefront of organizing local campaigns. She wanted the conference and NNHW materials to establish this role and cement the place of women as leaders in the Week.

In the end, the NNHW Committee did not select a particular year-round focus.

Instead, the bulletin encouraged organizers to either expand on the Special Campaign

Day theme or pick another health concern to fight throughout the year.183 There were too many different ideas, including an increased effort to reach out to non-medical people.

180 “Negro Health Week Conference,” November 1, 1926, 2, folder 2, box 1, NNHW, TA.

181 Susan M. Reverby, Ordered to Care: The Dilemma of American Nursing, 1850-1945 (Cambridge, MA: Cambridge University Press, 1987), 80; Patricia D’Antonio and Jean C. Whelan, “Counting Nurses: The Power of Historical Census Data,” Journal of Clinical Nursing, Oct: 18(19), 2009: 2717-2724.

182 “Negro Health Week Conference, Afternoon Session,” November 1, 1926, 3, folder 2, box 1, NNHW, TA. See also Melosh, “The Physician’s Hand,” 125-131.

183 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, 9, folder 1032, box 132, RMGC, TA. 270

Fans of this concept returned to the traditional NNHW emphasis on the importance of ministers, church groups, schools, teachers, and children in health education.184 However, the discussion at the meeting made the interests of the medical professionals in attendance clear. They wanted the medical establishment to be at the forefront of the

NNHW campaign, just as it was for poor and ethnic whites.

Criticism of NNHW

Not all African Americans embraced the campaign. Complaints centered on NNHW’s utility and the segregation the Week appeared to support. Regarding the former, even at the height of Baltimore’s NNHW campaign, the city’s black death rates continued to increase. As the Baltimore Afro-American put it, “While Baltimore is being awarded cups for the best program for Health Week, daily funeral processions bear mute testimony to the ineffectiveness of PROPAGANDA when conditions are not such as to adequately care for those who are ill and prevent the infection of others.”185 From the paper’s perspective, health advice and basic hygiene could only go so far because the conditions that African Americans lived in were so poor. Many whites blamed African Americans for their situation and portrayed them as either lazy or possessing racial characteristics that led them to live in these types of situations. However, such perceptions ignored the variety of adverse effects that systemic white racism had on African Americans. As the

Pittsburgh Courier explained, “white people are more responsible than Negroes for the

184 “Negro Health Week Conference, Afternoon Session,” November 1, 1926, 3-7, folder 2, box 1, NNHW, TA.

185 “Congratulations,” Baltimore Afro-American, August 14, 1926, 13. 271 present high death and sickness rates of the Aframerican[sic] population. It is because of industrial discrimination that relegates black people to the lowest paid ranks of labor, and housing segregation with its consequent disease breeding, that the black population suffers from a death rate twice as high as that of the whites.”186 A health campaign that only discussed health practices ignored the biggest issues facing African Americans and limited their ability to improve.

Other critics asserted that instead of promoting interracial cooperation and improved relations between the races, NNHW actually supported segregation. A physician writing in the New York Amsterdam News argued that NNHW “put the Negro in a class all to himself as not part of the body politic, whose health improvements need some special and peculiar attention, different to that of the other races who make up the population of the

United States.”187 Although NNHW provided African Americans with an opportunity to concentrate on the health issues they faced, the very fact that it focused on African

Americans reinforced segregation and the idea that blacks were inherently different from whites. As the Pittsburgh American noted, “the addition of a Jim Crow Health Week is an admission of physical inferiority and mental weakness on our part.”188 This perception of supporting segregation led some communities to refuse to participate. Shirley Wynne, the white Health Commissioner of New York City explained that the City would not participate in NNHW in 1930 because “The Health Department gives to the subject of the

186 “National Negro Health Week,” Pittsburgh Courier, November 13, 1926, “THC, 1926,” 820, TA.

187 “No Need for a National Negro Health Week,” New York Amsterdam News, March 5, 1924, “THC 1924,” 609, TA.

188 “National Negro Health Week,” Pittsburgh American, April 3, 1925, “THC 1925,” 152, TA. 272 health of the Negro…exactly the same consideration that it gives to the health of all other races.”189 The point, as many different groups declared throughout the late 1920s, was that health should not be a racial issue; it should be a national one.190

Developments in the Medical Establishment in the Late 1920s

In addition to the Week’s work on black health, Robert Moton also credited NNHW for improving interracial relations. As Moton explained, NNHW “has passed on from the mere matter of health to economic matters. I am very happy over the cooperation we can get anywhere now among the whites of any class on the question of health, and almost on the question of education, which, of course is a step forward to ineracial[sic] cooperation and good will.”191 Moton’s emphasis on NNHW’s role in improving race relations supported Washington and Du Bois’ earlier contentions about the interconnection between health and political and economic rights. However, Moton’s overzealous claims ignored the segregation aspect of NNHW. As the historian Bettye Collier-Thomas explains, even the inter-racial committees in many cities, which often supported NNHW, did not promote racial equality, “Often committees, conferences, and work referred to as interracial simply meant that the focus of the activity was on how to improve relations

189 “No Health Week in New York,” Baltimore Afro-American, April 12, 1930, 6. See also the explanation given for Cleveland not participating in NNHW in Virginia B. Wing to Albion L. Holsey, January 29, 1929, folder “1929 Health Week,” box 16, AH, TA. Despite Wynne’s comments, Brooklyn did observe NNHW, see “Brooklyn Y.W.C.A.,” Chicago Defender, March 29, 1930, 11.

190 H. L. Harris, “Negro Mortality rates in Chicago,” Social Service Review 1(1) March 1927: 58-77; Algernon B. Jackson, “The Need of Health Education Among Negroes,” Opportunity August 1924: 235-236; Wailoo, Drawing Blood, 139.

191 “Negro Health Week Conference,” November 1, 1926, 4, folder 2, box 1, NNHW, TA. 273 between the races. It did not mean that the group favored integration or that it was interested in abolishing segregation.”192

A prime example of NNHW’s interracial problems with segregation concerned the black hospital movement. At the meeting to plan the 1924 Week, Helen B. Pendleton of the American Red Cross argued for using the Week to increase the number of medical facilities for African Americans. While teaching health and disease prevention was certainly helpful, Pendleton argued that it did not solve the problem of what happened to

African Americans after they got sick. The medical facilities blacks could use were few and far between. Many of those that were available were of poor quality since white health departments often provided little funding.193 They also continued to be full of discriminatory, humiliating, and expensive policies. As historian David Beito elaborates,

“Many hospitals required black patients to bring eating utensils, sheets, and toothbrushes and to pay for a black nurse if none was on staff.”194 Combined with the high cost of hospital care, this situation limited African American ability and interest in using such facilities. For these reasons, they often remained at home when sick, infecting those living in the house and contributing to the high rates of disease.

This situation led black physicians and health professionals to begin to organize what became the black hospital movement in the 1920s. This movement represented both a step forward in terms of black access to professional medical care, and an acceptance of

192 Collier-Thomas, Jesus, Jobs, and Justice, 333.

193 “Health Week for Negroes Is Set,” January 19, 1924, “THC 1924,” 602, TA.

194 David T. Beito, From Mutual Aid to the Welfare State: Fraternal Societies and Social Services, 1890-1967 (Chapel Hill, NC: University of North Carolina Press, 2000), 183. The state of these facilities was similar in both the rural South and North. 274 segregation and Jim Crow. White philanthropists, many of whom worked with Tuskegee, supported this effort. In contrast, neither the American Medical Association (AMA) nor the American Hospital Association (AHA) allocated funding or personnel to support it.

African Americans had to start their own organization to support hospitals: the National

Hospital Association (NHA).195

The NMA was caught in the middle. It wanted more opportunities for its members to gain credentials, experience, and employment. However, as discussed earlier, fighting white racist attitudes in health was one of its main efforts. From this perspective, the black hospital movement appeared to accept the idea that black health was somehow different than white health.196 NNHW activities often included raising money for these institutions and generally supported their use by working with them to organize clinics and by having the physicians they employed as speakers.

White leaders did work with African Americans to increase the number of black medical professionals and clinics open to the race. However, the goal encouraged a paternalistic system, though this objective often led to a segregated one. More African

American physicians, nurses, and clinics, all certified and organized with white medical

195 Vanessa Northington Gamble is the expert on the subject of the black hospital movement. See Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York, NY: Oxford University Press, 1995), especially the introduction and page 184. See also Vanessa Northington Gamble, “Roots of the Black Hospital Reform Movement,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, ed. Judith W. Leavitt and Ronald L. Numbers, 3rd ed. (Madison, WI: University of Wisconsin Press, 1997): 369-391, especially 369-384; Karen Kruse Thomas, “The Hill-Burton Act and Civil Rights: Expanding Hospital Care for Black Southerners, 1939-1960,” Journal of Southern History 72(4) November 2006: 832-870, 837.

196 Gamble, Making a Place for Ourselves. See also Hine, Black Women in White. Hine’s study begins the black hospital movement earlier than Gamble’s, in 1890 instead of 1920 and Hine argues that the movement peaked in the 1920s. However, Hine gives more depth to her discussion of nurse training schools than hospitals and Gamble’s and Hine’s works together give a thorough overview of the black hospital movement. 275 establishment approval, meant that whites could oversee black health practices. At the same time, it would allow whites to avoid interacting with African American patients.197

Interestingly, while public health nurses played an important role in many NNHW campaigns to support black use of medical professionals for health maladies, their participation challenged the medical establishment. During this period, the AMA and other medical associations tried to assert more control over all those practicing health care. They wanted to increase the stature of the health professional and ensure that this person could make as much money as possible in the business of health care. Given this goal, the AMA tried to curb the practices of folk healers and other non-establishment health practitioners. However, it was not only those on the fringes of health care that caught the AMA’s ire. The group also fought to keep fraternal societies from hiring their own physicians, which gave these doctors a monopoly on care, and even tried to limit school clinics and opportunities for public health officials to treat illness.198

While the AMA had a lot of success in its efforts against folk medicine and fraternal societies, it had much more difficulty in regulating the public health nurse. Unlike private nurses, who usually worked in hospitals with physicians, public health nurses often worked in rural areas. This location made them difficult for doctors to supervise and required them to use their own judgement. Their independence worried physicians, and

197 Barbara Bates, Bargaining for Life: A Social History of Tuberculosis, 1876-1938 (Philadelphia, PA: University of Pennsylvania Press, 1992), 302; McBride, Integrating the City of Medicine, xvii; Hine, Black Women in White, 98; Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill, NC: The University of North Carolina Press, 2001), 47.

198 Beito, From Mutual Aid to the Welfare State, 124-128, 168-181; Starr, The Social Transformation of American Medicine, 185; Bonnie Bullough and George Rosen, Preventive Medicine in the United States, 1900-1990: Trends and Interpretations (Canton, MA: Science History Publications/USA, 1992), 70; Meckel, Classrooms and Clinics, 142. 276 even state health departments, who wanted to control these professional women. While

NNHW provided these women of the medical establishment an opportunity to expand their work and authority, public health nurses challenged the patriarchal tendencies within the medical profession.199

The racism rampant within the orthodox medical profession contributed to the widespread dissemination of misinformation regarding black health. Even with the advance of germ theory and the realization that, as the Peducah Sun put it, “public health authorities have recognized the limitations of police power in controlling diseases and of promoting better health,” beliefs tying disease to race persisted.200 Doctors often accused white sickle cell patients of having had an African American family member, and urged an end to intermarriage as a way to ward off the disease.201 Unfavorable attitudes towards educating African Americans about health persisted as well. The historian Keith Wailoo sums up the situation thus, “Blacks were portrayed as an undifferentiated and superstitious ‘folk,’ natural carriers of disease who were responsible for dangerous pathologies….”202 As such, the Vicksburg Post explained, “It is the duty of the white people to see that their negro neighbors are as healthy as it is possible to make them…”203

While whites and blacks might work together to promote health, it was up to whites to

199 Reverby, Ordered to Care, 103-128.

200 D. S. Ranshaw, J. S. Humphries, W. K. Walls, as quoted in “Health Week Is Marked By City,” Paducah Sun, April 3, 1928, “THC, 1928,” 351, TA. See for example: “Negro Health Week Begins April First,” Salisbury Post, March 9, 1928, “THC, 1928,” 368, TA.

201 Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore, MD: The Johns Hopkins University Press, 1997), 146.

202 Wailoo, Dying in the City of the Blues, 65.

203 “Negro Health Week,” Vicksburg Post, April 28, 1927, “THC, 1927,” 439, TA. 277 oversee black health work. The racist idea was that black health could not improve without white oversight. In other words, black people were not as intelligent as whites.

Thus, the primary reason the Vicksburg Post and other white NNHW supporters gave for participating in the campaign remained the same as in 1915. That is, better African

American health would benefit whites. It would lead to a decrease in taxes for hospitals to take care of black patients. Healthier black employees would increase production and income.204 While some no doubt looked at NNHW participation as a way to improve their greater communities, most whites perceived interracial work on health more as a means to benefit themselves.

Leadership and Recognition: Physicians in NNHW

Although Baltimore’s NNHW Committee could brag about its work in the mid-

1920s, it faced the instability that many other NNHW’s did. By 1928, financial concerns about paying for the health pamphlets and posters led Baltimore’s NNHW committee to rely more and more heavily on the State Department of Health for publicity and financial support. This change led to an increased focus on disease and medical practice in the content of the lectures and health talks around the city and broadcast on the radio. A medical focus required doctors to speak at NNHW meetings. Instead of discussing health practices that empowered lay people to assess health concerns on their own, physicians emphasized their role as health judges, giving speeches with titles such as, “Let Your

204 “Negro Health Week,” Vicksburg Post, April 28, 1927, “THC, 1927,” 439, TA; “National Negro Health Week,” Pittsburgh Courier, November 13, 1926, “THC, 1926,” 820, TA; McMurry, Recorder of the Black Experience, 117. 278

Doctor Decide.”205 Baltimore’s increase in physician leadership was part of a growing trend in local NNHWs during the late 1920s. In Chicago, where the Cook County

Physicians Association spearheaded the city’s NNHW in 1929, all 85 speakers were medical professionals.206 In addition to Chicago, physicians and the NMA helped lead

NNHWs in other urban areas, such as Dallas, Birmingham, Providence, Little Rock,

Milwaukee, and Washington, D.C., and public health nurses led in rural areas, such as

Pineville Kentucky, and Kent County Maryland.207

Regardless of their leadership position in NNHW, physicians, dentists, and nurses featured more and more prominently as speakers, demonstrators, and general arbiters of health. In Louisville, for example, physicians at NNHW clinics refused to declare a child

“physically fit” unless the child received immunization against diphtheria, typhoid, and smallpox.208 Doctors made their medical knowledge and medical practice the focal point.

205 “For Observance of Negro Health Week,” Baltimore Courier, March 9, 1928, “THC, 1928,” 354, TA; “Dentists to Hold Modern Office Health Week,” Baltimore Herald Commonwealth, April 2, 1927, “THC, 1927,” 436, TA; “Physicians to Head Health Week Program Here,” Baltimore Afro-American, March 22, 1930, A2.

206 William D. Giles and S. D. Hamilton, “Section I – The Organization and Set Up of the 1929 Health Campaign Committee,” n/d, 6, folder 19, box 2, NNHW, TA; “Section II - Report of the 1929 Health Campaign Committee,” n/d, 5-6, folder 19, box 2, NNHW, TA.

207 “Emphasize Tuberculosis in Fourth ‘Health Week,’” Chicago Defender, April 14, 1928, 10; William D. Giles and S. D. Hamilton, “Section I - The Organization and Set Up of the 1929 Health Campaign Committee,” n/d, 1-12, folder 19, box 2, NNHW, TA; “Local health Week Observance is Largest in History,” Dallas Express, April 9, 1927, “THC, 1927,” 461, TA; “Health Campaign in Birmingham A Great Success,” Birmingham Reporter, April 17, 1926, “THC, 1926,” 812, TA; “Health Week Plan of Colored Bodies,” Washington D.C. Herald, March 2, 1927, “THC, 1927,” 404, TA; “Negro Health Week,” Providence Tribune, April 11, 1927, “THC, 1927,” 454, TA; “Health Week for Negroes Set Aside,” March 25, 1928, “THC, 1928,” 332, TA; “Milwaukee to Observe Negro Health Week,” Milwaukee Enterprise, March 31, 1928, “THC, 1928,” 384, TA; “The 1926 National Negro Health Week,” Durham Times, March 19, 1926, “THC, 1926,” 849, TA; “N.M.A. Head Tells Plans for New Year,” Chicago Defender, December 31, 1927, 10; “Negro Health Week,” Pineville Sun, April 7, 1927, “THC, 1927,” 433, TA; “Sixteenth Annual National Negro Health Week, March 30-April 6, 1930, as observed in Kent County, Maryland.” folder 7, box 3, NNHW, TA.

279

Health practices, such as proper hand washing, were not as important as vaccinations.209

This context limited the impact lay leaders could have on black health improvement.

For Moton, the increased focus on using medical professionals was a necessity given that “There is no greater factor in raising the health standards of the race than the physician.”210 Many saw the benefit of educating the public about the advantages of seeing a doctor and having a regular exam.211 In addition to promoting regular checkups,

NNHW clinics often included education for mothers about how to better care for their children, a task many thought best suited medical professionals.

The emphasis on seeing medical professionals and utilizing medical professional resources also reflected changes in the African American population. At the beginning of the decade, two-thirds of blacks lived in rural areas. However, by 1930 this figure had decreased to 57% as the Great Migration led many more African Americans to live in the urban areas where black doctors lived.212 By the end of the 1920s, one-fifth of all blacks

208 “Negro Health Week April 1 to 8,” Louisville News, March 10, 1928, “THC, 1928,” 350, TA; “Report on Negro Health Week: March 31 – April 7, 1929, Louisville, Kentucky,” Negro health Week Committee of the Health Council Cooperating with the Kentucky Inter-Racial Commission, March 31 – April 7, 1929, 1-3, folder “Health Week Reports,” box 16 AH, TA.

209 It is worth pointing out that within the context of the present situation with the Coronoa Virus, the medical definition of what constitutes practing “good health” was the same then as now in terms of hand washing, not spitting, and other basic practices.

210 “Doctors Push Program for Negro Health Week Work,” New York Age, March 13, 1926, “THC, 1926,” 810, TA; “Doctors Push Program for Negro Health Week Work,” Birmingham Reporter, March 13, 1926, “THC, 1926,” 822, TA.

211 See for example: “Health Week to be Held for Negroes,” Hartford Courant, April 2, 1927, “THC, 1927,” 401; “Stewed Caterpillars Warned Against,” Baltimore Afro-American, March 2, 1929, 17.

212 U.S Bureau of the Census, Statistical Abstract of the United States, 1935 (Washington, D.C.: U.S. Department of Commerce, 1935), 19; Julian H. Lewis, “Number and Geographic Location of Negro Physicians in the United States,” Journal of the American Medical Association 104(14) April 11, 1935: 1272-1273. 280 lived in Northern and Western states and one-third in cities and towns, pushing NNHW beyond the target population that Cumming had described in 1926 as “the rural people, the farming element.”213 Although, as discussed earlier, being in an urban area did not necessarily mean African Americans would see a medical professional, the geography that used to limit access was no longer a factor for many. However, cost was a factor for the majority of urban African Americans who were poor. The onset of the Great

Depression exacerbated this situation.

To encourage more doctors to participate in NNHW, organizers used a variety of strategies, including public shaming. While commending the Cook County Medical

Association for its NNHW work, the Chicago Bee asserted, “Those [doctors] that are not interested members display a lack of real zeal and concern in public health of the people and are not worthy of the support of the people whose interests they neglect.”214 The

NNHWC’s radio address for 1930 declared that “Members of medical, dental, and nursing societies have the professional responsibility” to participate in NNHW.215

However, by 1930, NMA leaders had become frustrated with what they perceived as a lack of recognition for their work. That year, the NNHW pamphlet only included the organization’s address, with no explanation of the NMA’s work or its participation in the

213 Embree, “Negro Illness and the Nation’s Health,” 84, 97; “Negro Health Week Conference,” November 1, 1926, 1, folder 2, box 1, NNHW, TA; U.S Bureau of the Census, Statistical Abstract of the United States, 1935 (Washington, D.C.: U.S. Department of Commerce, 1935), 15.

214 “The Health Campaign,” Chicago Bee, April 6, 1929, “THC, 1929,” 178, TA. For more critical discussions of physician participation, see C. R. S. Collins, “Parents, Preachers and Teachers! Hear This Health Message,” Norfolk Journal and Guide, March 23, 1929, “THC, 1929,” 191, TA.

215 Roscoe C. Brown, “National Negro Health Week,” n/d, 3, folder 8, box 4, NNHW, TA. 1930 was the first year the NNHWC created what became an annual radio address. 281 campaign.216 NMA President George Bowles sent a letter to Cumming in March, just before NNHW started, demanding greater acknowledgment of the role the NMA played in not only NNHW, but African American health generally. He argued that omitting any mention of NMA contributions to NNHW within the bulletin would give the impression that the NMA was “either not interested or not willing to assume our share of the responsibility in the effort for Negro health education.”217

Furthermore, as Bowles saw it, “We [The NMA] are not contending for leadership in matters so vital as public health; but we do feel that we are entitled to rightful recognition and co-operation in all matters of public health education, especially when such education is designated to benefit a particular racial group of which we are a part.”218

Here Bowles walked a fine line. He did not want to offend Cumming and risk losing PHS support for African American health, but he still felt the need to advocate for his group’s interests. NMA member C. A. Lassow perhaps put the feelings of the NMA more succinctly, asserting that the NMA “should have been and…should be the first to be invited, consulted and around which the Negro Health Week should be promulgated.”219

216 “National Negro Health Week: Sixteenth Annual Observance {1930}, Sunday, Mary 30, to Sunday, April 6,” PHS, Washington, D.C., 1930, back inside cover, folder 3, box 1, NNHW, TA. Earlier NNHW pamphlets provided only a little more information, though they did acknowledge NNHW participation, see: “National Negro Health Week: April 1 to 8, 1928,” PHS, Washington, D.C., 1928, 23, T27.2:N31/928, OUL; “National Negro Health Week: Fifteenth Annual Observance (1929), Sunday, March 31, to Sunday, April 7,” PHS, Washington, D.C., 1929, 16, folder 21, box 2, NNHW, TA.

217 “Medical Association Asks Part in Health Week Program,” Baltimore Afro-American, March 22, 1930, 7; “National Medical Association Executive Demands Recognition on Negro Health Week Program,” Pittsburgh Courier, March 22, 1930, “THC, 1930,” 512, TA.

218 “Medical Association Asks Part in Health Week Program,” Baltimore Afro-American, March 22, 1930, 7; “National Medical Association Executive Demands Recognition on Negro Health Week Program,” Pittsburgh Courier, March 22, 1930, “THC, 1930,” 512, TA.

282

While it was clear that the PHS could provide much more publicity and financial support for the Week, the NMA thought that black doctors should be at the forefront of the health movement. Yet campaign organizers often appeared interested in limiting their impact. For example, the 1926 bulletin instructed participants to consult with the AMA and AHA, not the NMA or NHA, if they wanted to use the Week to campaign to build a hospital.220 Those physicians on the committee to judge NNHW awards also felt ignored.

As Dr. W. W. Peter explained, “Frankly, I am not particularly interested, as a public health worker, in judging a health campaign by the number of houses painted.”221 Peter and other physicians wanted a much greater focus on vaccinations, clinics, and medical professional use than the campaigns of the late 1920s provided. Yet, as discussed earlier, the winning campaigns continued to emphasize cleaning up and whitewashing, seemingly ignoring the voices of black doctors.

Some saw Bowles’ March 1930 letter to Cumming as an attempt to get credit for a movement from which the NMA was largely absent. The Baltimore Afro-American questioned whether the NMA only publicized its participation because the PHS had approved of NNHW. The newspaper also noted the lack of NMA participation over the life of NNHW and raised the question of whether the publicity, rather than the cause, was really driving the NMA. As the editor put it, “Does the association [NMA] want a share and a part of the responsibility of the celebrations, or does it want a mere mention in the

219 C. A. Lassow to “Dear Doctor,” October 9, 1929, folder 1, box 1, NNHW, TA.

220 “National Negro Health Week: April 4 to 10, 1926,” PHS, Washington, D.C., 1926, 8, T27.2: N31 926, box T702, “Publications of the Federal Government,” RG 287, NARA II.

221 W. W. Peters to Albon Holsey, July 27, 1928, “Cleanliness Institute” folder, box 15, Albon Holsey Collection (AH), TA. 283 pamphlets being distributed?”222 Lastly, the Afro-American questioned the NMA’s choice of who to complain to. The NMA could have asked the NNBL or even Tuskegee for more acknowledgment, though it likely would not have gotten it since Booker T.

Washington and his disciples led these conservative accomodationist groups. Instead, it skirted these non-medical groups to appeal directly to the PHS.223 Regardless, while

Bowles’ letter did not convince the PHS to republish the 1930 NNHW, the issue spurred the NMA to become more involved in NNHW leadership when an opening formed at the end of 1930.

Financing the Week

As with most campaigns, one of the biggest issues organizers faced had to do with money. Simply put, even with the support of the PHS and other cooperating organizations, NNHW had a small budget. While the PHS funded pamphlets and posters, it would not commit dollars without having the ability to oversee their use and refused to completely subsidize the NNHW bulletin. By 1928, the bulletin had ballooned to more than 30 pages to include the suggestions of all the groups aiding the Week. It fell to the

NNHW Committee, and especially Monroe Work, to reduce the number of pages in the bulletin, which would lower costs and allow PHS to decrease the price.224 Work’s streamlining helped decrease the price from $20/1000 bulletins and $30/1000 posters in

222 “Are the Medics Ready to Work Now?” Baltimore Afro-American, March 29, 1930, 6.

223 “Are the Medics Ready to Work Now?” Baltimore Afro-American, March 29, 1930, 6.

224 Roscoe Brown to Monroe Work, September 17, 1928, folder 5, box 1, NNHW, TA; Work to Carter, October 12, 1929, folder 11, box 1, TA; “National Negro Health Week Conference,” October 30, 1928, 1, folder 14, box 2, NNHW, TA. 284

1928 to $12.50/1000 bulletins and $10/1000 posters by 1930.225 These lower prices on the 7,000 bulletins and 2,000 posters Tuskegee Institute bought every year in the late

1920s allowed it to distribute these materials for free or at a low fee.226

Yet even with the price reductions, the publication and campaign costs remained a major concern for the NNHWC and Moton.227 What Moton really wanted was an influx of money from a philanthropic organization. To that end, he turned to the Julius

Rosenwald Fund, a charity he already worked with as President of Tuskegee. Rosenwald, the Sears, Roebuck and Company President, designed the fund with two principles in mind. First, to avoid the bureaucracy he saw in other funds, he required the fund to disperse its more than $70 million within 25 years of his death. Second, he dedicated the

Fund to supporting African Americans and promoting social reform and their personal growth. To that end, most of the money went towards initiatives in education and health, areas Rosenwald felt most philanthropists overlooked.228 Since Moton had already worked with the Rosenwald Fund to build schools in rural areas throughout the South, he tried to entice the Fund to support NNHW as well.

Moton’s suggestion appealed to the Fund’s leaders. The Fund had already begun financing the development of black hospitals and medical colleges, and had provided

225 Robert Moton to Superintendent of Documents, Government Printing Office, December 12, 1928, folder 1252, box 156, RMGC, TA; “Health Week Bulletin Has Been Published,” New York Age, March 1, 1930, “THC, 1930,” 478, TA.

226 “1926,” folder 11, box 1, NNHW, TA.

227 “Preliminary Conference Regarding National Negro Health Week, 1930,” 2-3, October 19, 1929, folder 11, box 1, NNHW, TA.

228 Edwin R. Embree and Julia Waxman, Investment in People: The Story of the Julius Rosenwald Fund (New York, NY: Harper & Bros., 1949), 30-33. 285 states with money to hire black health professionals in the South.229 As discussed earlier,

NNHW’s Committee had also bandied about the latter idea, and local NNHWs had led initiatives in support of this goal.230 In West Virginia for example, the local NNHW push for black public health nurses was so strong that the state health department agreed to pay half the salaries if the communities paid the other half.231 On paper, the goals of the campaign and the Fund appeared aligned and a partnership made sense.

The Fund’s outreach in health concentrated on supporting the medical establishment.

When the Fund wanted to conduct a thorough investigation into NNHW’s health education activities before making a financial commitment, it assigned a representative to attend NNHW meetings. The representative chosen, Dr. Taliaferro Clark, was a member of the PHS and the medical establishment. This meant that the PHS would have direct influence on any new funding, increasing PHS and medical establishment importance in

NNHW, and limiting the influence of Tuskegee’s lay professionals.232

Roscoe Brown argued that it was up to Tuskegee’s leaders to convince the Fund’s

President, Edwin R. Embree, to support the Week. According to Brown, the Fund would be more likely to support NNHW if its leaders saw “some evidence of self-help.”233 Such

229 McBride, From TB to AIDS, 75-78.

230 “Negro Public Health Week is Inaugurated Here Today,” Galveston News April 4, 1920, “THC, 1920,” 553, TA; “Addresses Feature Opening Day of Negro Health Week,” Galveston News April 5, 1920, “THC, 1920,” 553, TA.

231 “Negro health Work in West Virginia Is Receiving Careful Attention From State Department: Statistics Given,” April 6, 1927, “THC, 1927,” 465, TA.

232 Michael Davis to Robert Moton, November 23, 1929, folder 1211, box 152, RMGC, TA.

233 Roscoe Brown to Robert Moton, December 31, 1929, folder 1252, box 156, RMGC, TA. 286 a comment might seem surprising given the name of the public health campaign.

However, by 1929 it appeared to some that the PHS was running NNHW with help from

Tuskegee, and not the other way around. After all, Washington, D.C., not Tuskegee, was the host of the big annual NNHW planning meeting, and it was the PHS that printed the bulletin and posters. Tuskegee therefore had to increase its visibility in the Week, which meant spending more money.

To entice the Fund and demonstrate NNHW’s work in self-help, in 1929, Tuskegee became the base of operations for organizing the year-round health campaign. While this year-round effort had been a continual goal of the PHS, it was not part of Moton and

Work’s original vision. In addition to planning, Tuskegee also had to contribute money for housing, equipment, and supplies to support the year-round portion of NNHW.234

Even though Moton and Work supported efforts that would enhance the visibility and appeal of NNHW, such expenditures were onerous for Tuskegee.

Additionally, Moton and Work could claim that the NNHW campaign had demonstrated a great deal of popularity. In 1930, 31 states, including practically every state between Connecticut and Texas, had at least one community participate in NNHW.

While the South still had the most participation by far, the PHS’ publicity efforts combined with the Great Migration of African Americans out of the South and to the

North and West to expand the campaign. Brown estimated that the record 505 NNHW reports the NNHWC received represented only one-fifth of the total number of

234 Roscoe Brown to Robert Moton, December 31, 1929, folder 1252, box 156, RMGC, TA; “Preliminary Conference Regarding National Negro Health Week, 1930,” 3-4, October 19, 1929, folder 11, box 1, NNHW, TA. 287 communities that participated, and the Baltimore Afro-American claimed that the 1930

NNHW reached 1,000,000 people, 10% of all African Americans.235

In addition to the increase in participation, African American health continued to improve. During the late 1920s, the rate of TB decline in blacks surpassed that of whites and the African American death rate decreased from 20.2/1000 in 1915 to 16.3/1000 by

1930.236 While still higher than the white rate of 11.7/1000, the statistics demonstrated to

Moton that NNHW “may be regarded as an institution definitely contributing to better health habits and the prevention of disease.”237 Metropolitan Life Insurance Company statistician Louis I. Dublin went further, arguing that the race’s trend toward better health was in its infancy “It must be remembered that the public health movement among

Negroes is only of very recent origin and the full effect of the work will not be felt for years to come.”238 Far from becoming extinct, African Americans had demonstrated their ability to care for themselves.

While the Week’s leaders trumpeted their accomplishments, their work must be kept in perspective. Many advances in medicine, public health, municipal services, and sanitation occurred during the early twentieth century, all of which helped to decrease

235 “Preliminary Conference on the National Negro Health Week of 1931,” 2-3, folder 9, box 4, NNHW, TA; “Health Week Change,” Baltimore Afro-American, November 29, 1930, 6; “Negro Health Week Observance,” N/D, folder 2, box 1, NNHW, TA. While, as discussed, some whites participated in NNHW, the vast majority of campaign organizers and attendees were black.

236 “Health Education Will Cut Tuberculosis Rate,” The Tuskegee Messenger, April 13, 1929, 5; U.S Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970 (Washington, D.C.: U.S. Department of Commerce, 1975), 59. The census statistics are for “Negro and other races,” but African Americans were by far the largest portion of this group.

237 “Health News,” Jackson News, July 25, 1925, “THC 1925,” 119, TA. The newspaper quoted a letter Moton wrote to Cumming.

238 Louis I. Dublin, “Recent Improvement in the Negroes’ Mortality,” Opportunity 1(4), April 1923: 5-8, 5. 288 death rates throughout the country. The numbers of trained health workers, dentists, nurses, and hospitals all increased, which allowed people greater and faster access to treatment options than ever before. The 6,719 hospitals in the country by 1930 were a

25% increase over the 1920 figure, and the 955,869 beds they offered was a 56% increase.239 Government regulation of water and milk supplies helped reduce childhood mortality.240 Anti-TB and other public health campaigns and journals continued to educate people about germ theory, hygiene, and disease prevention during this period.241

Throughout the 1920s, the racialization of disease decreased as physicians gave greater weight to environment, housing, hygiene and basic health education as the causes for disease and health disparities between blacks and whites.242 New technological improvements helped as well. The number of people receiving filtered water increased from 30,000 in 1880 to 20 million by 1920. Most of the filtered water went to people in urban areas, which helped to significantly reduce the typhoid death rate.243 As the number

239 Reverby, Examining Tuskegee, 180.

240 Gretchen A. Condran, Henry Williams, and Rose A. Cheney, “The Decline in Mortality in Philadelphia from 1870 to 1930,” in Judith Walzer Leavitt and Ronald L. Numbers ed., Sickness and Health in America: Readings in the History of Medicine and Public Health, Third Edition, Revised (Madison, WI: The University of Wisconsin Press, 1997): 452-466.

241 Collier-Thomas, Jesus, Jobs, and Justice, 332; McBride, From TB to AIDS, 111.

242 Smith, Sick and Tired of Being Sick and Tired, 47; McBride, From TB to AIDS, 32; James Jones Bad Blood: The Tuskegee Syphilis Experiment (New York, NY: Free Press, 1981), 23; Beardsley, A History of Neglect, 11-13.

243 Charles-Edward Amory Winslow, The Evolution and Significance of the Modern Public Health Campaign (New Haven, CT: Yale University Press, 1923, reprint (South Burlington, VT: Yale University Press, 1984), 38. 289 of African Americans in urban areas continued to increase, these advances outside of direct black control had a significant impact on their health improvement.244

Additionally, it is worth noting that the NNHW campaign occurred at the same time as a variety of other efforts to improve African American health. In addition to the work of the NMA, the National Association of Colored Graduate Nurses (NACGN), and the black hospital movement, in 1928, the NACW launched a better homes drive to improve the dress, deportment and hygiene of black children.245 Religious organizations also got involved, most notably the Federal Council of the Churches of Christs’s Church

Women’s Committee on Race Relations (CWCRR). As the result of a horrific automobile accident in which Fisk University Dean of Women Juliette Derricott died because a white hospital refused to care for her, the CWCRR “extended membership to prominent

African American social and political activists associated with secular organizations” such as the NACGN and Alpha Kappa Alpha Sorority, to join with the CWCRR in its efforts to desegregate hospitals and nursing schools.246

In addition, Tuberculosis associations began to include blacks in the movement, rather than forcing them to make separate organizations. The historian Samuel Kelton

Roberts Jr. explains this decision as “a response to the fear of the incorrigible black consumptive.”247 However, while not a reflection of progressive efforts to improve race

244 Harry F. Dowling, City Hospitals: The Undercare of the Underprivileged (Cambridge, MA: Harvard University Press, 1982), 88.

245 Deborah Gray White, Too Heavy a Load: Black Women in Defense of Themselves, 1894-1994 (New York, NY: W. W. Norton, 1999), 131.

246 Collier-Thomas, Jesus, Jobs, and Justice, 339-340.

247 Roberts, Jr., Infectious Fear, 142, 163, 191. 290 relations, the inclusion of African Americans in NTA work was another way for African

Americans to support the race’s health. NNHW predated and publicized the work of these groups, who then partnered with NNHW and used the campaign to build greater support for their efforts toward improving black health. So, at the very least, a correlation existed between improved African American health and the expansion of NNHW.

However, even with all of Moton’s and Work’s efforts at Tuskegee, the Great

Depression made the issue of financial support paramount. With the Rosenwald Fund dragging its feet and the Paint-Up Bureau among other long-term supporters forced to reconsider their financial commitments in the new economic world, NNHW faced significant challenges as organizers met for the annual meeting on October 29, 1930.248

To fully finance and support the Week, to increase its connections with supporters, and to better establish the year-round component, the conference attendees voted to move

NNHW headquarters from Tuskegee to Howard University in Washington, D.C.

Ostensibly, changing headquarters made a lot of sense. First, it allowed for better cooperation between the NNHW Committee and the PHS, as the two organizations would now be much closer geographically. Second, the promise of improved closeness, both geographically and cooperatively, alleviated the Rosenwald Fund’s worry regarding medical establishment leadership in the Week. The Fund decided to support NNHW and

248 Monroe Work to Robert Moton, April 24, 1930, folder 1252, box 156, RMGC, TA; Albon Holsey to Monroe Work, July 15, 1930, folder 7, box 3, NNHW, TA. 291 cover the travelling expenses of NNHW Committee chairman Roscoe Brown for 20 months.249

The move also allowed medical and health organizations, including the NMA, to increase participation because many of these groups had headquarters in the Northeast and the Washington, D.C. area in particular. People could now attend impromptu meetings and coordinate better, and in more detailed ways, with an organization near a major population center with easy access to transportation. Lastly, having Howard

University run NNHW left the Week under African American leadership and ensured blacks still had significant sway over the campaign’s structure and implementation.

Although Howard University’s Numa Adams, Dean of the Medical School, and

Michel Dumas, a doctor and member of the school’s board of trustees, suggested Howard take charge of NNHW, Robert Moton quickly supported the move. He explained that

“Tuskegee is always willing to turn over to others who may be better equipped, the special interests which it has fostered.”250

Although Work also voted to support the move, he did not share Moton’s altruism.

Only six months prior to the vote, he asserted that NNHW headquarters should remain in the South because that was where most African Americans lived. More to the point, he argued that given the Week’s emphasis on interracial cooperation, “There is no place from which the cooperation of whites and Negroes in the South can be secured to the

249 M. O. Bousfield, “National Health Program,” April 22-24, 1931, 2, folder 7, box 5, NNHW, TA; “Health Week Headquarters Moved From Tuskgee to Howard,” Baltimore Afro- American, November 22, 1930, 2.

250 “Preliminary Conference on the National Negro Health Week of 1931,” 4-5, folder 9, box 4, NNHW, TA; “Health Week Change,” Baltimore Afro-American, November 29, 1930, 6. 292 extent that this can be done from Tuskegee.”251 From Work’s perspective, the Institute’s connections to white organizations and charities made it a centerpiece for health work.

Even with this caveat, the Baltimore Afro-American captured the thinking of Tuskegee’s leaders when it noted, “The transfer…doesn’t mean that Tuskegee is weary of good work, but merely places Health Week so close to the U.S. Surgeon General that it can knock on his door more frequently.”252

While neither Moton nor Work fought against the move, it disappointed both that the

PHS did not decide to run the Week itself.253 The exact reasons for PHS disinterest are unclear, but it seems likely that a combination of money, time, and racist concerns about the political implications of government support of an African American movement made it reluctant to take a bigger role in the campaign. The reasons Work and Moton supported

PHS takeover are clearer. Both realized the potential breakthrough that government, not just support, but leadership, of an African American health program represented. It would legitimize their work, vastly increase the Week’s ability to reach blacks, and potentially serve as a foundation upon which to build other interracial efforts to promote black racial uplift throughout the country. The PHS vision of a year-round movement also meant more resources would go towards NNHW.

Yet both Tuskegee leaders would have known that a move to Howard, together with financial support from the Rosenwald Fund, would come with substantial changes. The

251 Monroe Work to Robert Moton, April 24, 1930, folder 1252, box 156, RMGC, TA.

252 “Health Week Change,” Baltimore Afro-American, November 29, 1930, 6.

253 Monroe Work to Robert Moton, April 24, 1930, folder 1252, box 156, RMGC, TA; “Preliminary Conference on the National Negro Health Week of 1931,” 5, folder 9, box 4, NNHW, TA. 293 first, and most obvious, was potentially limiting the influence of non-medical personnel in setting the NNHW agenda, and in particular Tuskegee’s control of the campaign. In her examination of African Americans in nursing, the historian Darlene Clark Hine accuses the foundations that gave financial support to nursing programs, such as the

Rosenwald Fund and Rockefeller Foundation, of “playing a subtle game of social control.”254 As Hine illustrates, these groups tied funding to specific objectives that

African American leaders did not always share. However, if they wanted the money, support, and publicity, they had to go along with what these white-led groups prioritized.

Writing in 1935, Dr. Louis T. Wright made a similar observation about the Rosenwald

Fund specifically, asserting that “the Julius Rosenwald Fund has attempted to control every field of thought as it relates to the Negro problem.”255

In terms of NNHW, the Fund had manipulated Tuskegee to take on a year-round health campaign from 1929 to 1930. According to M. O. Bousfield of the National Negro

Insurance Association (NNIA), after the Fund decided to participate in the campaign, the

Fund Trustees, “are said to have been instrumental in having had the headquarters changed from Tuskegee to Howard University.”256 In addition to decreasing the direct influence of non-medical personnel in the Week, the changes the Fund influenced aided medical establishment efforts to take greater control of NNHW. When the NNHW fall conference committee moved to establish a new national committee to oversee year-

254 Hine, Black Women in White, xxii.

255 Louis T. Wright, “Factors Controlling Negro Health,” Crisis, September, 1935: 265, 280, 284, 280.

256 M. O. Bousfield, “National Health Program,” April 22-24, 1931, 2, folder 7, box 5, NNHW, TA. 294 round programming, six of the seven people appointed had medical backgrounds. This number included Field Secretary Roscoe Brown, who now held a second leadership position in addition to that of NNHW Committee Chairman. Monroe Work was the lone exception.257 Such influence would allow medical professionals to realign the campaign towards a greater focus on the use and benefits of medical professionals. Thus, the relocation to Howard University had the potential to completely alter the original mission of NNHW.

The NMA was ecstatic about the changes. Of the five people on the national committee, four were NMA members.258 Some might have perceived the NMA’s increased role as a culmination of Bowles’ letter to Surgeon General Cumming.

However, it’s worth noting that the NMA’s influence grew only after it offered to make a financial commitment to NNHW.259 Regardless, the NMA’s new stature emboldened it to declare a new, medical directive for the campaign. As the JNMA put it, “the Negro health program would [now] be developed under the leadership of members of the N.M.A., and of the medical profession in general everywhere as never before.”260 The Committee

257 “Preliminary Conference on the National Negro Health Week of 1931,” October 29, 1930, 1-5, folder 9, box 4, NNHW, TA; “Minutes of the Meeting of the executive Committee of The National Negro Health Week (Movement).” October 29, 1930, 2, folder 9, box 4, NNHW, TA; “National Negro Health Week: 17th Annual Observance, Sunday, April 5, to Sunday, April 12, 1931,” PHS, Washington, D.C., 1931, 2, folder 2, box 5, NNHW, TA. Committee members: Roscoe Brown was a dentist and PHS employee, Numa P.G. Adams was Dean of the School of Medicine at Howard University, M. O. Bousfield of the National Negro Insurance Association had an MD, George W. Bowles was Chairman of the Executive Board of the NMA, R. C. Williams was an Assistant Surgeon General. The Director was Dr. Algernon B. Jackson of Howard University.

258 Roscoe Brown, Numa P.G. Adams, M. O. Bousfield, and George W. Bowles.

259 R. C. Williams and Roscoe C. Brown, “United States Public Health Service Preliminary Conference on the National Negro Health Week of 1931,” October 29, 1930, 4, folder 9, box 4, NNHW, TA.

295 named this year-round campaign with medical professional leadership the National Negro

Health Week Movement.

According to the historian Samuel Kelton Roberts Jr., during the interwar years there arose, “a new liberal racial consensus, often called interracial cooperation. Frequently funded by philanthropic largesse, political and intellectual collaborations of black medical and social science leaders with their white counterparts resulted in professional partnerships in education, labor, and health.”261 On the surface, the development in

NNHW discussed in this chapter support Roberts Jr.’s conclusions. NNHW’s leaders, at both the grassroots and national level, collaborated with white organizations and professionals to improve African American health education. Black and white doctors worked together to conduct talks on health, and health departments worked with community leaders to improve sanitation in African American communities.

Yet what occurred with NNHW was also different from Roberts Jr.’s generalization.

When “philanthropic largesse” finally found NNHW, it altered the makeup of NNHW leadership. The Week was also not as “collaborative” as it might have appeared. As this chapter has shown, leaders debated choices about what health information to emphasize, and who would do the emphasizing, leaving some, such as the NMA, feeling ostracized at times. While it excited Moton and Work that NNHW would live on at Howard, their loss of influence in the Week quickly became apparent.

260 “National Negro Health,” JNMA, 23(1) 1931: 37.

261 Roberts, Jr., Infectious Fear, 63. 296

CHAPTER 5

THE LEADERSHIP OF THE PUBLIC HEALTH SERVICE:

IT’S NOT ABOUT CLEANING UP ANYMORE, 1931-1941

In making this transfer to Washington with headquarters at Howard University, the definite hope is entertained that with the aid of the Rosenwald Fund… it [the National Negro Health Week/Movement] will at length become a definite and permanent phase of the United States Public Health Service.

– Robert Moton1

With these words, Robert Moton summed up his dream for the Week. Howard’s leadership would be a stopgap, a pause, on the way to the ultimate goal of having NNHW become a fully funded government campaign. Achieving this objective for a program that

African Americans launched would represent a crowning achievement, the first ever government funded health program to support African American health. As Moton’s statement indicates, neither the exact focus of the campaign, nor its leadership worried

Tuskegee’s president; just the program’s adoption.

Organizing the NNHM

One of the reasons that Howard was able take on the Week was because of the financial contributions of the federal government, the Rosenwald Fund, and outside sources. Between November 1, 1930 and June 30, 1932, the PHS gave $1,666.67 in publications, postage, and other services. Tuskegee, the NMA, the NNIA, and a few other

1 “Principal’s Annual Report Edition, 1930-1931” The Tuskegee Institute Bulletin 25(3) July 1932, Tuskegee, AL, 19. 297 groups, such as the National Clean-up and Paint-up Bureau, combined to contribute the same amount. The Rosenwald Fund provided the greatest financial backing, $6,833.33.2

While Howard did not donate a specific figure, as the headquarters of the Movement it contributed office space, equipment, and telephone services, worth an estimated $1,500.3

With $11,666.67 in monetary support, the Movement could now afford to pay its leadership. As Field Secretary, Brown received $300 a month and a budget for travel and correspondence that he could use to help improve the organization of the Week as the

Movement’s Committee worked on year-round participation.4

After establishing financial stability, the Movement’s Committee attempted to identify specific health issues for improvement. At an early January meeting, the

Committee noted that “the great need for health centers, clinics, public health nurses and other health workers was… an immediate challenge to the Movement.”5 This statement signaled the Movement’s interest in focusing on the medical establishment to support black health improvement, not particularly surprising given that six of the seven people on the Committee had medical degrees.

2 Although a significant amount of money in the eyes of Work and others, this was just a pittance of the $1.7 million the Fund spent on African American health initiatives during its tenure, most of which went towards funding black hospitals, clinics, and health centers. See Edwin R. Embree and Julia Waxman, Investment in People: The Story of the Julius Rosenwald Fund (New York, NY: Harper & Bros., 1949), 121.

3 Numa Adams to Emmett Scott, February 3, 1931, “National Negro Health movement, 1932,” Mordecai Johnson Collection (MJ), Howard University Archives, Washington, D.C (HU).

4 George W. Bowles and Numa P. G. Adams, Minutes of the Executive Committee of the National Negro Health Movement, January 8, 1931, 3, “National Negro Health movement, 1932,” MJ, HU; Monroe Work to Robert Moton, April 17, 1931, folder 12, box 5, National Negro Health Week Collection (NNHW), Tuskegee University Archives, Tuskegee, AL (TA).

5 George W. Bowles and Numa P. G. Adams, Minutes of the Executive Committee of the National Negro Health Movement, January 8, 1931, 4, “National Negro Health movement, 1932,” MJ, HU. 298

In addition to promoting a better working relationship with local and state health officers; trying to stimulate more opportunities for black medical professionals, particularly nurses; and emphasizing health work in schools; NNHM became a “clearing house” of health information.6 Not only did it maintain a list of health speakers and qualified health workers for NNHW lectures and general black public health efforts, but the NNHM Committee also began collecting publications from a wide variety of health agencies. NNHM also worked with the PHS and NMA to obtain all books, papers, and studies relating to the health of African Americans. In this way, NNHM sought to position itself as the primary outlet for black health information.7 This goal required the

NNHM to work more closely with those in the medical establishment, further cementing the connection between this public health campaign and medical professionals.

While the NNHM Committee expanded NNHW activities and efforts, it also attempted to restrict the calls for racial equality in health and society that had started to imbed themselves in local campaigns. For example, one of the meetings during

Baltimore’s 1926 Week included a talk by John O. Spencer of Morgan College advocating the end of segregated railroad cars.8 In contrast, as Howard University

President Mordecai Johnson put it, the Movement “is a practical, cooperative effort to

6 M. O. Bousfield, “National health Program,” Read before the Eleventh Annual session of the NNIA in Hot Springs, Arkansas, April 22-24, 1931,3- 9, folder 7 , box 5, NNHW, TA.

7 M. O. Bousfield, “National health Program,” Read before the Eleventh Annual session of the NNIA in Hot Springs, Arkansas, April 22-24, 1931,6- 9, Folder 7 , Box 5, NNHW, TA.

8 “Live 100 Years Says Senator Copeland Here,” Baltimore Afro-American, April 17, 1926, 1. 299 improve the health of the people,” and it should “not violate its purposes and objectives through political or other activities.”9

As discussed in previous chapters, health was a political issue that came to encompass the broadest dimensions of African American life in America, from housing to poverty to racism. Local organizers used NNHW to advocate against discrimination in health, be it hospital access or the hiring of black public health officials. These grassroots activists also used NNHW to organize around improving housing conditions and pay – issues relevant to poor health. Limiting the political work of the Movement was a cogent move toward neutrality given government funding and the prevalence of racist attitudes towards blacks.10

NNHM and NNHW

As the Movement’s Committee became more involved, it was at times difficult to discern the difference between the Movement and the Week. According to Roscoe

Brown, the campaign needed two arms because “the National Negro Health Week as a short campaign, however intensive, cannot comprehend the full problem of the health of the colored population and render its fullest potential effectiveness; hence, a year-round movement is proposed.”11 The Week’s limited length gave it the ability to generate short-

9 George W. Bowles and Numa P. G. Adams, Minutes of the Executive Committee of the National Negro Health Movement, January 8, 1931, 5, ““National Negro Health movement, 1932,” MJ, HU.

10 David McBride, Integrating the City of Medicine: Blacks in Philadelphia Health Care, 1910-1965 (Philadelphia, PA: Temple University Press, 1989), xviii. . 11 Roscoe C. Brown, “National Negro Health Week,” N/D, 6, folder 9, box 5, NNHW, TA. 300 term interest in health. Part of the NNHM’s purpose, however, was to think long-term about health and examine broader health concerns.12

The Committee’s goals for the Week and Movement made the distinction between the two more apparent. According to Brown, the Week’s two objectives were: “(1) To provide practical suggestions for the local Health Week Committees that conduct the observance, and (2) to stimulate the people as a whole to cooperative endeavor in clean- up, educational, and specific hygienic and clinical services for general sanitary improvement of the community and for health betterment of the individual, family, and home.”13

Brown’s aims for the Week were similar to those of the original NNHW program in that they mostly focused on health education and community cleaning. However, the

Movement’s ten point year-round goals demonstrated a more significant break. These points went beyond just working with state health officers on black health issues, creating lists of speakers, gathering health information, and promoting NNHW. For Brown, key elements of the year-round campaign included “Stimulate employment of Negro public health personnel [and] Improve training and quality of Negro nurses.14 According to

Brown, as the Week grew it “naturally and logically assumed other phases of health conservation, such as clinics for treatment, inoculation, and periodic health

12 M. O. Bousfield, “National health Program,” Read before the Eleventh Annual session of the NNIA in Hot Springs, Arkansas, April 22-24, 1931, 9, folder 7, box 5, NNHW, TA.

13 Roscoe Brown, “National Negro Health Week Movement,” Journal of Negro Education (JNE) 6(3), 1937: 553-564, 555.

14 Brown, “National Negro Health Week Movement,” 559. 301 examination.”15 These phases could start during the Week, but they needed support to grow throughout the year in order to be effective. A week was not enough time to get a black public health official hired, but a year-round effort would allow the local NNHW committee to demonstrate why the community needed such a person.

To reinforce year-round work, the NNHM Committee imitated NNHW, assigning a health activity for each month of the year. These monthly tasks encouraged local NNHW committees to continue to function year-round, laying the groundwork for communities to create stronger and more far-reaching NNHWs in the future. These monthly goals included a combination of medical establishment support and lay organization involvement. For example, dentists and doctors would help oversee physical exams from

January-March and the pre-school clinic in August. However, lay people could promote healthy outdoor activities and organize student health parades during the summer.16 This duality meant that NNHM preserved some of NNHW’s original mission of including lay people as leaders in health and granting them autonomy in how they supported NNHW and NNHM.17 Yet much of the year-round program still concentrated on the medical establishment. NNHM plans included breaking down the racist barriers that deprived

African Americans of having a say in the decisions, of city and county health

15 Brown, “National Negro Health Week Movement,” 558.

16 “National Negro Health Week: 18th Annual Observance, Sunday, April 3, to Sunday, April 10, 1932,” PHS, Washington, D.C., 1932, 10, folder 3, box 6, NNHW, TA.

17 George W. Bowls and Numa P. G. Adams, Executive Committee of the National Negro Health Movement meeting minutes, March 17, 1931, 2, folder 12, box 5, NNHW, TA. 302 departments that impacted black communities and denied black medical professionals employment in hospitals and other health facilities.18

The two committees for the campaigns contained a lot of overlap. On the Executive

Committee of the NNHM sat George W. Bowles of the NMA as Chairman, with

Algernon Jackson as Director, and Roscoe Brown as Field Secretary. All of these men had medical degrees and could aptly be described as part of the medical establishment.

The rest of the committee members were Numa P. G. Adams of Howard, M. O. Bousfield of the National Negro Insurance Association (NNIA), R.C. Williams of the PHS (the only white member), and Monroe Work. The NNHW Committee remained the same as before, with Brown as Chairman, Work as Secretary, and Jackson and R. Maurice Moss serving alongside the reverend F. Rivers Barnwell after James Bond passed away in 1929.19

Given the overlapping memberships and the way the NNHM and NNHW Committees organized themselves, the NNHM’s medical professional leadership could direct the focus of the NNHW with Roscoe Brown’s chairmanship of the NNHW Committee’s more lay personnel.

Within the NNHM and NNHW structure, Brown, Jackson, and Work each had multiple roles and a significant influence on NNHM and NNHW. However, on a day-today basis, Work’s location at Tuskegee limited his impact. Jackson, who worked at

Howard, and Brown, who now also worked there in addition to the PHS, were both in

18 “The Health Problem of the American Negro,” N/A, March 15, 1932, 4-5, folder 3, box 6, NNHW, TA.

19 “National Negro Health Week: 17th Annual Observance, Sunday, April 5, to Sunday, April 12, 1931,” PHS, Washington, D.C., 1931, 2, folder 2, box 5, NNHW, TA; “National Negro Health Week: 18th Annual Observance, Sunday, April 3, to Sunday, April 10, 1932,” PHS, Washington, D.C., 1932, 3, folder 3, box 6, NNHW, TA. 303

Washington. They could easily meet with committee members, most of who also worked in the northeast. It was not as easy for Robert Moton, to accept invitations to participate, or even for Work, who missed meetings and other opportunities to direct both NNHM and NNHW.20 As such, the medical experts within the NNHM and NNHW leadership strengthened their control, which culminated at the NNHM’s Executive Committee meeting on March 17, 1931.

With Monroe Work unable to attend, the Committee accepted a proposal that “the medical profession (including its several constituents) should exercise initiative and direction of the health programs.”21 When the Committee discussed the place of social agencies in NNHM, R. C. Williams of the PHS stated that “the proper approach [for organizing local NNHWs] was through the constituted official health authority and agency, that is the health officer and the health department.”22 That a government official would advocate the use of government agencies to organize a public health campaign is unsurprising. What is surprising is the acceptance this statement received given the important role grassroots organizers and organizations had played to support and create

Weeks in areas devoid of medical professionals. Again, with more medical experts on the

20 R. N. Davis to Robert Moton, October 10, 1931, folder 2, box 5, NNHW, TA; George W. Bowles and Numa P. G. Adams, Minutes of the Executive Committee of the National Negro Health Movement, January 8, 1931, 1, “National Negro Health movement, 1932,” MJ, HU; George W. Bowles and Numa P. G. Adams, Executive Committee of the National Negro Health Week Movement meeting summary, January 19, 1932, 1, folder 3, box 6, NNHW, TA; George W. Bowls and Numa P. G. Adams, Executive Committee of the National Negro Health Movement meeting minutes, March 17, 1931, 1, folder 12, box 5, NNHW, TA.

21 George W. Bowls and Numa P. G. Adams, Executive Committee of the National Negro Health Movement meeting minutes, March 17, 1931, 1-2, folder 12, box 5, NNHW, TA.

22 George W. Bowls and Numa P. G. Adams, Executive Committee of the National Negro Health Movement meeting minutes, March 17, 1931, 2, folder 12, box 5, NNHW, TA. 304

NNHM and NNHW Committees, the Week’s emphasis on the medical professional as the leader in health had become more pronounced.

Although Tuskegee’s leaders became less vocal in the Week and Movement, under

Howard University the Week’s materials remained relatively similar to those used prior to the headquarters transfer. Like the 1930 bulletin, those under Howard’s purview noted the daily health themes and suggested activities. They also contained pictures of participation and recognized prize winners from urban and rural communities.23 The

Week’s national leaders also continued to promote Figure 4 health as an opportunity for interracial cooperation. Although some of these photos displayed whites examining and giving talks to

African Americans instead of participating in cleanups alongside them, the message was that whites cared about black health. Both the 1931 bulletin and radio address noted that Booker T. Page 12 of the 1932 NNHW Washington’s 1915 call asked for 14 agencies and Bulletin organizations to participate in the Week, all of which were for blacks. By contrast, of the

36 groups asked to participate in the 1931 Week, just 13 were exclusively for African

23 “National Negro Health Week: 17th Annual Observance, Sunday, April 5, to Sunday, April 12, 1931,” PHS, Washington, D.C., 1931, folder 2, box 5, NNHW, TA; “National Negro Health Week: 18th Annual Observance, Sunday, April 3, to Sunday, April 10, 1932,” PHS, Washington, D.C., 1932, 2, 8, 12, folder 3, box 6, NNHW, TA. 305

Americans. Additionally, the bulletin noted the work the mostly white city and state health officers had done to organize and support past NNHWs throughout the country.24

The NNHM and NNHW Committees also took a few steps to generate more participation. Specifically, the NNHW Committee changed the way it awarded prizes.

Instead of recognizing three communities, the NNHW Committee introduced Certificates of Merit. As in the past, the NNHW Committee asked that communities send in reports on their accomplishments during the Week, noting the number of lots cleaned, lectures given, and attendance figures at clinics. The NNHW Committee then awarded points based on participation and activities, and rewarded communities with various seals based on participation.25 This new certificate program allowed the NNHW Committee to conceivably honor every community that participated in NNHW, allowing more communities to celebrate their work and see appreciation for it beyond the confines of their local community. The NNHW Committee hoped that the opportunity for recognition would lead more communities to organize campaigns. Committee members also thought that rewarding those that excelled would encourage the best programs to continue their work.26 In addition to local communities, to foster greater participation and cooperation

24 “National Negro Health Week: 17th Annual Observance, Sunday, April 5, to Sunday, April 12, 1931,” PHS, Washington, D.C., 1931, 11, folder 2, box 5, NNHW, TA; Roscoe C. Brown, “National Negro Health Week,” N/D, 2-3, folder 9, box 5, NNHW, TA.

25 “National Negro Health Week: 17th Annual Observance, Sunday, April 5, to Sunday, April 12, 1931,” PHS, Washington, D.C., 1931, 5, folder 2, box 5, NNHW, TA.

26 Roscoe C. Brown to “To the Successful participants in the National Negro Health Week Observance For the Year 1931,” N/D, Received August 4, 1931, folder 02916, box 368, Central File 1929-32, Record Group (RG) 102 (Records of the Children’s Bureau), National Archives and Records Administration, College Park, MD (NARA II); Roscoe Brown to “To the Successful Participants in the National Negro Health Week Of the Year 1933,” N/D, folder 6, box 11, NNHW, TA. 306 in the Movement, Brown also awarded certificates to the Children’s Bureau and other agencies and groups that participated.27

Using thinking similar to that behind the certificates, the NNHWC also introduced poster contests for elementary and secondary students. While public health campaigns aimed at poor whites and European immigrants also included poster contests, the competitions were almost entirely local.28 By contrast, the NNHWC poster competition encouraged and expanded the contests many local affiliates already organized. Each school held its own competition and sent the winning poster to the NNHWC to choose a national winner, which would serve as the following year’s NNHW poster.29 At one fell swoop, the NNHW Committee had solved its poster design needs and found a way to further engage schools and young children in the Week beyond clinics and health lectures.

To address concerns about birth defects and the high mortality rates of infants and young children in the black community, the NNHM introduced a “Better Babies

Certificate of Examination.” Parents already regularly took their kids to clinics and physicians during NNHW. The certificate stated that the medical professional had checked for proper physical and mental development and asked the doctor or nurse to assign a score based on the checkup. Parents could then send in the certificate for national

27 Katherine F. Lenroot to Roscoe C. Brown, August 5, 1931, folder 02916, box 368, Central File 1929-32, RG 102 (Records of the Children’s Bureau), NARA II.

28 See for example “‘Watch Your Sneeze’ or Spread Disease,” The Survey: Social, Charitable, Civic: a Journal of Constructive Philanthropy (The Survey) 35(14) January 1, 1916: 371; Virginia R. Wing, “The Beauty Motif,” The Survey 59(4) November 15, 1927: 207-210, 207.

29 “National Negro Health Week: 18th Annual Observance, Sunday, April 3, to Sunday, April 10, 1932,” PHS, Washington, D.C., 1932, 9, 11, folder 3, box 6, NNHW, TA. 307 leaders to affix their signature and acknowledgment.30 The rating system indicated that medical experts were the lone arbiters of health and health improvement, as only they could assign the scores.

The use of certificates had the potential to alter local participation. Communities continued to hold baby contests and other competitions that identified a single, healthy winner. The idea was that these competitions provided a more significant award, one that all competitors would want, such as appearing in the local paper and being celebrated as the health standard for the community. Theoretically, such an award would create massive appeal to participate, leading to better health understandings and outcomes.

However, in Chicago NNHW leaders used certificates, rather than contests, to encourage participation. During the city’s 1932 Week, everyone who got a checkup, regardless of their health report, received a certificate. As M. O. Bousfield explained,

“Our object should be to award the individual for his effort to increase the physical efficiency of the race as a whole and to compliment him for his personal contribution to that problem.”31 Crowning a “healthiest kid” encouraged parents to pay more attention to medical guidelines for raising healthy children. Providing everyone a certificate served as an incentive for participation in NNHW. Thus, Chicago’s “NNHW certificates” promoted

30 “National Negro Health Week: 18th Annual Observance, Sunday, April 3, to Sunday, April 10, 1932,” PHS, Washington, D.C., 1932, 11, folder 3, box 6, NNHW, TA.

31 M. O. Bousfield, “National health Program,” Read before the Eleventh Annual session of the NNIA in Hot Springs, Arkansas, April 22-24, 1931, 16, folder 7, box 5, NNHW, TA. 308 the idea that the uplift of the race involved all African Americans and reinforced the importance of seeing medical professionals.32

The NNHW efforts at Howard were similar to those of Tuskegee in the late 1920s.

Grassroots organizing remained the primary mechanism for creating campaigns. The health issues local groups concentrated on ranged from health practices regarding proper diet and rest, to medical practice concerns about immunizations, clinic use, and annual exams.33 This last focus provided another illustration of how physicians had still not fully convinced the African American public of the necessity of exams, medical care and treatment, or even of doctors as the best source for curing ills.34 And the instruction in health practices that had begun to decrease during the 1920s stopped entirely. The 1931 and 1932 bulletins did not include anything about whitewashing, privies, or even how basic hygiene could combat disease. There were a couple reasons for this omission. First, the movement’s focus was no longer concentrated largely on the rural South where these practices made the most sense to emphasize. Second, whitewashing, cleaning privies, and

32 M. O. Bousfield, “National health Program,” Read before the Eleventh Annual session of the NNIA in Hot Springs, Arkansas, April 22-24, 1931, especially 16-18, folder 7, box 5, NNHW, TA.

33 See for example: Edith Dowd, “St. Louis Billikens in Health Program,” Chicago Defender, April 23, 1932, 16; “Paine College,” Chicago Defender, April 23, 1932, 4; “Paine College Observe Negro Health Week,” Savannah Journal, April 13, 1932, “Tuskegee Health Collection (THC), 1932,” 1027-1028, TA; J. W. Henry Jr., “Texas State News,” Chicago Defender, April 16, 1932, 22; “Observance Report Negro Health Week in Warren County,” Warrenton Clipper, April 15, 1932, “THC, 1932,” 1026, TA; “Negro Health Week Opens,” Christian Recorder, April 7, 1932, “THC, 1932,” 1033, TA; 10,000 Attend Health Week Meeting Here,” Baltimore Afro- American, April 23, 1932, “THC, 1932,” 1030, TA; “Negro Health Week Observance Set For April 3-10, Inclusive; Virginia Agencies Now Active,” Norfolk Journal and Guide, March 31, 1932, “THC, 1932,” 1038, TA.

34 M. O. Bousfield, “National health Program,” Read before the Eleventh Annual session of the NNIA in Hot Springs, Arkansas, April 22-24, 1931, 14-17, folder 7, box 5, NNHW, TA. 309 basic hygiene had become accepted as standard legitimate practices for addressing issues of health and disease.

Yet PHS involvement, combined with Howard’s location in a large urban area with easy access to media and NNHW’s partner organizations, and NNHM’s expansion of

NNHW activities, continued the upward trend in participation year-to-year. According to

Hugh Cumming, demand for the 1931 NNHW bulletin and poster exceeded supply by

50%. More impressively, Roscoe Brown counted 1,325 communities definitely participating in 1931, an increase of 162% from 1930.35

From African American to PHS Control

Although the NNHM Committee could point to the increase in NNHW participation as a measure of its success, by January of 1932, the Great Depression had undermined the financial footing of the Movement yet again. Both Bowles’ NMA and Bousfield’s NNIA reported that their respective groups and members faced economic hardships that prevented them from donating to NNHM.36 Additionally, and more importantly, in early

March, Michael Davis, the Director for Medical Services for the Julius Rosenwald Fund decided that the Fund would no longer finance the Week.37 This news sent the Week’s

35 H.S. Cumming to “To the Participants of the national Negro Health Week Observance For the Year 1932, April 3, to April10,” February 1, 1932, folder 3, box 6, NNHW, TA; “Preliminary national Negro Health Week Announcement for the Eighteenth Annual Observance, Sunday, April 3, to Sunday, April 10, 1932,” PHS, Washington, D.C., N/D, 2-3, folder 2, box 6, NNHW, TA.

36 George W. Bowles and Numa P. G. Adams, Executive Committee of the National Negro Health Week Movement meeting summary, January 19, 1932, 1-2, folder 3, box 6, NNHW, TA.

37 As reprinted in a letter from Numa P. G. Adams to Monroe Work, April 6, 1932, “Health Week,” folder, box 58, Robert Moton Local Correspondence (RMLC), TA. 310 leaders into a panic. Roscoe Brown had assumed that even if the Fund made this decision, it would decrease its contributions gradually over a few years, instead of terminating them outright at the end of the fiscal year, June 30, 1932.38

From the Rosenwald Fund’s perspective, the decision was not at all sudden. Davis had written NNHM secretary Adams almost a year prior explaining that the Committee should not rely on funding after the original 20-month grant ended. The Fund’s work with Dr. Taliaffero Clark gave Davis access to the minutes of NNHM meetings and he cited the NNHM Committee’s own words in warning it against making such assumptions.39 Although Davis did not state the exact cause of the Fund’s decision, it seems that its many other financial commitments, combined with the economic hardships of the time, spurred the Fund to end its partnership, rather than any fault of the NNHM.40

Inappropriate assumptions aside, the NNHM Committee was now in a bind with no guaranteed funding past June 30, 1932, and the Committee held an emergency meeting on May 3 to assess the future of NNHM and NNHW. At this meeting, Clark and R. C.

Williams, both of the PHS, suggested the Service take over NNHM/NNHW. Clark assured the combined Committee’s that if they agreed, the Rosenwald Fund would

38 George W. Bowles and Numa P. G. Adams, Minutes of the Executive Committee of the National Negro Health Movement, January 8, 1931, 2, “National Negro Health movement, 1932,” MJ, HU; Numa P. G. Adams to Monroe Work, April 6, 1932, “Health Week” folder, box 58, RMLC, TA.

39 Michael Davis to Numa P. G. Adams, April 7, 1931, folder 12, box 5, NNHW, TA.

40 George W. Bowles, Numa P. G. Adams, and Roscoe C. Brown, Minutes of the Executive Committee of the National Negro Health Movement, May 3, 1932, 2, “ “Health Week,” folder, box 58, RMLC, TA. 311 continue to subsidize Brown’s salary.41 On the surface, this offer may appear straightforward. The PHS knew a lot about the inner-workings of the NNHM. It already produced the bulletin and posters for NNHW and Surgeon General Cumming and his

Assistants had sat in on many NNHW meetings and served on the NNHM and NNHW

Committees. Additionally, the PHS’s location in the capital meant that the relocation from Howard University would be relatively easy. The Fund would continue to participate due to the increased stature the Movement would have with expanded government support, which might in turn grant it increased status in working with the government on other projects. However, granting PHS control of NNHW would remove the Movement and Week from the direct control of African Americans.

The takeover was a seminal moment in the history of NNHW. While the Great

Depression forced this decision on the PHS, the Service could have chosen to let the campaign end. That it did not is a testament to the work of black community organizers and the Roosevelt administration’s recognition of the growing political power of African

Americans. All those on the Committee welcomed this move, which fulfilled Moton’s and Work’s 1930 ambitions.42

41 George W. Bowles, Numa P. G. Adams, and Roscoe C. Brown, Minutes of the Executive Committee of the National Negro Health Movement, May 3, 1932, 2, “ “Health Week,” folder, box 58, RMLC, TA.

42 Monroe Work to Robert Moton, April 24, 1930, folder 1252, box 156, Robert Moton General Correspondence (RMGC), TA; “Preliminary Conference on the National Negro Health Week of 1931,” 5, folder 9, box 4, NNHW, TA; Robert Moton to Numa P. G. Adams, May 14, 1932, “Health Week” folder, box 58, RMLC, TA. Work was unable to attend this meeting, see: George W. Bowles, Numa P. G. Adams, and Roscoe C. Brown, Minutes of the Executive Committee of the National Negro Health Movement, May 3, 1932, 1.“ “Health Week,” folder, box 58, RMLC, TA; Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890-1950 (Philadelphia, PA: University of Pennsylvania, 1995), 81. 312

From the perspective of the PHS, the reasons for taking over NNHW might appear less clear. After all, this was only two years after its last opportunity to run the Week, a chance it had declined. Additionally, everyone and all organizations, including the government, felt the Great Depression’s impact, so taking on a campaign that would increase costs might seem counterintuitive. However, if the mission of the PHS was to improve the health of the nation, NNHM represented a unique opportunity. During the

1920s, the PHS and other health leaders made a concerted effort to convince white

Americans, particularly the middle-class, of the value of physicians and hospitals in health improvement. Magazines, such as the American Medical Association’s (AMA)

Hygeia and the American Public Health Association’s The Nation’s Health, led the charge in increasing white American’s confidence in, and use of, medical professionals.43

The AMA and APHA journals mostly overlooked African Americans who, as discussed throughout this work, continued to view the medical establishment with a wary eye, often trusting midwives and folk healers with their health. As more health experts attacked the race extinction thesis and focused on the environment and germ theory as the prime culprits of ill health, the connection between white and black health became clearer and more accepted. Since germs did not accept racial barriers, the way to improve the nation’s health was health education for all Americans.44 This is not to suggest that white

43 David McBride, From TB to AIDS: Epidemics among Urban Blacks since 1900 (Albany, NY: State University of New York Press, 1991), 111.

44 McBride, From TB to AIDS, 111; Edward H. Beardsley, A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South (Knoxville, TN: University of Tennessee Press, 1987), 25; Grace Abbott, “Methods By Which Children’s Health May Be Improved,” Opportunity 2(13) (January 1924): 10-11; Edwin R. Embree, “Negro Illness and the Nation’s Health,” Crisis 36(3) (1929): 84, 97; Franklin O. Nichols, “Social Hygiene and the Negro,” Journal of Social Hygiene 15(7) (October 1929): 408-413. 313 health professionals saw the two races as equal or believed there were no differences between the two races. For example, many still asserted that blacks were particularly susceptible to TB.45 Yet such an observation made improving their environment and medical care all the more acute. To implement such a program, health leaders needed a health forum that African Americans already trusted: NNHW/NNHM.

By 1932, the Movement had demonstrated its ability to reach the average African

American. As the historian David McBride puts it, NNHM provided “a communication bridge for the federal public health movement into the black lay community at the local, personal, household level.”46 At this level, the government could alter the health perceptions and values of the average African American since NNHM/NNHW had created a framework to instill health messages. The PHS’ goal was to get African

Americans more comfortable with the medical establishment since, as McBride explains,

“Only when blacks had accepted the cultural authority of the physician and modern medical treatment could they be expected to attend clinical programs.”47 Thus, on the one hand, PHS control of NNHM provided the Service with the ability to direct black health priorities, as the agency’s white leadership perceived them, to a receptive black audience.

On the other hand, however, the establishment of the Office of Negro Health Work within the PHS to coordinate NNHM represented a crowning achievement for African

Americans. According to the historian Susan Smith, “It was the first time since the

Freedmen’s Bureau of the post-Civil War Era that the federal government

45 James Jones Bad Blood: The Tuskegee Syphilis Experiment (New York, NY: Free Press, 1981), 40.

46 McBride, From TB to AIDS, 109.

47 McBride, From TB to AIDS, 111. 314 institutionalized black health work within the federal bureaucracy.”48 Furthermore, as

Jesse O. Thomas of Atlanta’s National Urban League explained, “The Fact that the federal government has adopted the Negro Health Week as its own project is an unmistakable testimony that the government has recognized the beneficial results that have come from the activities of this organization on one hand, and it is disposed to assume a larger share of its responsibility in connection with the health of this frequently,

‘forgotten 10 per cent’ of our population.”49 By taking on NNHM, the PHS legitimized the place of African American health as a national priority and established a pathway for future government aid to improve black health and outreach throughout the country.

Yet at the same time as the PHS promoted African American health nationally, it limited it locally during its 40-year syphilis experiment at Tuskegee. Begun the same year that the PHS took over NNHM, the purpose of the experiment was to study the long-term effects of syphilis on African American men. The proposal of such a study illustrated that leading medical thinkers still believed that the effects of diseases differed by race and that they still conceived of what was “normal” as white. As the medical historian Christopher

Crenner explains, when it came to medical studies “Research subjects were identified by race only in the few instances involving comparison with nonwhite groups.”50 To examine the impact of syphilis on blacks, the PHS chose to withhold treatment. Even

48 Smith, Sick and Tired of Being Sick and Tired, 58.

49 Jesse O. Thomas, “N/T” Atlanta Constitution, March 12, 1934, “THC, 1934,” 663, TA.

50 Christopher Creener, “Race and Laboratory Norms: The Critical Insights of Julian Herman Lewis (1891-1989),” Isis 105, no. 3 (September 2014): 477-507: 499, see also 492. On racial differences in syphilis specifically, see for example Susan M. Reverby, Examining Tuskegee: The Infamous Syphilis Study and its Legacy (Chapel Hill, NC: The University of North Carolina Press, 2009), 151, 158-162, 178-179. 315 when doctors discovered penicillin as a cure, the study’s leaders continued not to treat the participants. Perhaps more damning, doctors never told participants what disease they had, that it was contagious, or how it was transmitted.51

While the white medical establishment, in the form of Clark, Cumming, and Thomas

Parran Jr., who would become Surgeon General in 1936, led the call to conduct this experiment, many in the African American community supported it as well. Dr. Eugene

Dibble Jr., successor to John Kenney as head of the John A. Andrew Memorial Hospital at Tuskegee, pushed Moton to allow the study to take place. Dibble argued that the study would provide opportunities for training nursing students and interns. Racial discrimination severely limited these kinds of activities for blacks and the Great

Depression caused them to all but disappear. Additionally, Dibble asserted that the study would bring increased publicity and exposure to Tuskegee due to the study’s perceived importance.52 A partnership with Tuskegee also benefitted the PHS. The Service could say it cooperated on the study with black leaders, a more palatable position than having a white-led government organization run a study on blacks without their input.53

It may at first seem counterintuitive for the PHS to support a campaign promoting

African American health while also conducting this study. After all, many of the efforts at the national, state, and local level surrounding the Week concentrated on promoting awareness and prevention of syphilis and venereal diseases generally. The Tuskegee

51 Jones, Bad Blood, 1, 7, 74, 161; Allan M. Brandt, “Racism and Research: The Case of the Tuskegee Syphilis Study,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, Judith Walzer Leavitt and Ronald L. Numbers ed., Third Edition, Revised (Madison, WI: The University of Wisconsin Press, 1997): 392-404, 398-399.

52 Jones, Bad Blood, 101-103; Reverby, Examining Tuskegee, 40, 158-162.

53 Jones, Bad Blood, 111; Brandt, “Racism and Research,” 397. 316

Syphilis Experiment not only involved keeping health information from African

Americans, but it also included racial prejudice in its rationale. As the historian Allan M.

Brandt puts it, “The premise that blacks, promiscuous and lustful, would not seek or continue treatment, shaped the study.”54 However, the historian James Jones puts such thinking in perspective, arguing that “Compared with the real black-baiters of the day…the racism of these health officers was mild. Their prejudices took the form of paternalism.”55

From Jones’ perspective, the Syphilis Study and the NNHM campaign appear in the same vein. They both involve PHS officials who want African American health to improve. The stated purpose of the study was to get a better understanding of syphilis, which would, in theory, help the African American community as the disease disproportionately affected blacks. In order to conduct the study, the white PHS felt that they knew better than the African American professionals on site how to run the study and get the most out of the research; hence, the decision to keep participants, and even some of Tuskegee’s black staff, in the dark about the exact methodology of the study.56

The NNHM campaign was similar in that it put the PHS in a position where it could direct the health messages it thought best for the African American community.

Additionally, while at the highest level both programs involved white leadership and financing; African Americans were responsible for the day-to-day operations. Thus, the two programs tapped into the white medical establishment’s need to oversee and direct

54 Brandt, “Racism and Research,” 395.

55 Jones, Bad Blood, 41.

56 Brandt, “Racism and Research,” 397. 317 all health programs, white and black, making them, in Jones’ words, “racial liberals by the standards of the 1930s.”57

The NNHM Under the PHS, the Early Years: 1933-1936

The PHS decision to run the NNHM was in line with other New Deal policies of the time in that it indicated some government concern for African Americans. However, the

PHS made its decision in early May of 1932, under Republican leadership and more than eight months before Franklin Delano Roosevelt took office. It would be teleological to argue that the PHS foresaw the administration’s interest in, if not aiding, then at least in reaching out to African Americans. If anything, Republican administrators might have hoped this act would convince African Americans to support their Party. Instead, as discussed earlier, the prime motive for the PHS takeover was to increase its reach and fulfill its goal of creating a healthier public. While, as Clark and others noted, there was some interest in expanding opportunities for black health professionals, this was not a driving force in the decision, and neither was promoting racial equality.

The most obvious way that NNHM changed under PHS leadership after its May takeover was that it began producing a quarterly journal, the National Negro Health News

(News).58 Its regular publication reinforced the perception that black health was important

57 Jones, Bad Blood, 172.

58 Although quarterly, this journal did not contain a July-September issue in either 1933 or 1934, and ended abruptly with the April-June issue of 1950. It’s worth noting here that, in consultation with Tab Lewis, NARA Archivist, and Sonja N. Woods, Archivist at the Mooreland- Spingarn Research Center at Howard University, I was unable to locate the records of the Office of Negro Health Work or the personal papers of Dr. Roscoe C. Brown. I must come to the same conclusion that Susan L. Smith did more than twenty years ago, when she concluded that neither of these records are available anymore, see Smith, Sick and Tired of Being Sick and Tired, note 318 to the government. Furthermore, as NNHW Chairman, Roscoe Brown ran the News and used it for two purposes. The first was as a communication tool to get out word about the

Week. He included information about the poster contest, certificates of merit, calls for participation, the text of radio addresses, and other promotional materials. He also published statistics on national participation as well as the reports of various communities on their particular Weeks. As opposed to the few small articles and pictures in the bulletin, leaders now had a place they could turn to for a multitude of ideas on organizing and activities, as well as to see evidence that their participation was part of a larger campaign.

The second purpose of the News was to fulfill NNHM’s “clearing house” initiative for information on the state of black health in America.59 The News reprinted and published articles on a variety of issues related to black health, including studies on specific diseases, such as TB and venereal disease; discussions of local community initiatives to improve black health; and opportunities for black health professionals.60

While some community leaders read the News, its content appealed most to health officers, medical professionals and others tied to the PHS.61

#4 on 191.To fill this gap, I have read the entirety of the National Negro Health News (NNHN) and collected a variety of other materials available from Tuskegee University’s Health Collection, NNHW, and the NARA materials available.

59 See Roscoe C. Brown, “Memorandum of Transmittal of the Health Week Number,” NNHN, Vol. 1, No. 2, April-June 1933, N/P.

60 There are a long list of examples, but early ones include: Taliaferro Clark, “The Negro Tuberculosis Problem,” NNHN 1(2) 1933: 17-18; Rose Henderson, “Health Gains for Negroes,” NNHN 1(3) 1933: 19-20; “Stage Clinic for Negro Physicians,” NNHN 1(3) 1933: 20.

61 Annual Report of the Surgeon General of the Public Health Service of the United States: for the Fiscal year 1939 (Washington, D.C., Government Printing Office, 1939), 106. 319

The News represented a new way of engaging with those interested in NNHW and

NNHM. For cost reasons, the PHS reduced the length of the NNHW bulletin to eight pages. The decrease in length meant that it could not go into detail about particular health problems. Instead, the bulletin now concentrated on informing readers about the Week’s schedule, awards and contests, filling out the NNHWC’s report forms, and how to organize participation.62 The discussions of diseases NNHW bulletins of the 1920s had included were now the purview of the News. Under the PHS, the purpose of the bulletin had changed. It was no longer to educate African Americans about what practices they could implement to improve their health or to explain medical ideas to the lay public. To some degree, black newspapers picked up these discussions. By the 1920s, it was common practice for black newspapers and magazines to feature advice columns, general articles focused on black health and to advertise and discuss the local activities of

National Negro Week.63 Instead, the bulletin’s sole use under the PHS was as a cheap community organizing tool.64

62 “Annual National Negro health Week Conference for the Year 1933 Observance,” NNHN, Vol. 1, No. 1, January-March 1933, 8. The program was only 8 pages from 1934-38. In 1939 it increased to 12 pages, then to 16 in 1940 before going back to 8 in 1941.

63 For the Baltimore Afro-American, see for example “Orangebur, SC,” Baltimore Afro- American, April 25, 1925, 17; “East Orange, N.J.,” Baltimore Afro-American, April 3, 1926, 18; “Newark, N.J.,” Baltimore Afro-American, April 10, 1926, 15; “New Jersey: Society,” Baltimore Afro-American, April 7, 1928, 16; “Raleigh, N. C.,” Baltimore Afro-American, April 21, 1928, 19. For the Chicago Defender, see for example the column “Dr. A. Wilberforce Williams Talks On,” such as the column on March 19, 1921, 12 and the column on August 18, 1932, 12. See also for example “New York City Briefs,” Chicago Defender, April 9, 1921, 9; “No ‘Death Beds,’ in Texas for Tubercular Patients,” Chicago Defender, April 9, 1921, 13; “Indiana State News,” Chicago Defender, March 24, 1923, 17; “North Carolina,” Chicago Defender, May 1, 1926, A7. For the Pittsburgh Courier, see for example “Louisville Social Notes,” Pittsburgh Courier, March 20, 1926, 7; “Portland, Ore.,” Pittsburgh Courier, April 3, 1926, 13; “Atlantic City, N.J.,” Pittsburgh Courier, April 16, 1927, 11.

64 Annual Report of the Surgeon General of the Public Health Service of the United States: for the Fiscal year 1934 (Washington, D.C., Government Printing Office, 1934), 91; 320

Identifying what “disease problems” needed attacking was the domain of the News.

Although it still discussed sanitation and hygiene, it continued the PHS’ push to focus the

Week/Movement on illness.65 Articles on TB, syphilis, and venereal diseases were common, as many medical professionals considered these diseases to be the most significant affecting African Americans. Even articles on the general state of black health often contained notes on one of these illnesses. NNHW reports from local communities on the success of their clinics noted the number of people discovered to have these diseases. The News even published the winning submission to the National Tuberculosis

Associations’ (NTA) essay contest.66

Under the direction of Surgeon General Hugh Cumming, and with the addition of the

News, the PHS emphasis on disease over hygiene, and the medical establishment over do- it-yourself health, became even more apparent in the grassroots movement. Communities turned their Weeks to focus on diphtheria, syphilis, malaria, TB, and other illnesses.67

Annual Report of the Surgeon General of the Public Health Service of the United States: for the Fiscal year 1936 (Washington, D.C., Government Printing Office, 1936), 101-102.

65 Annual Report of the Surgeon General of the Public Health Service of the United States: for the Fiscal year 1934 (Washington, D.C., Government Printing Office, 1934), 91; Annual Report of the Surgeon General of the Public Health Service of the United States: for the Fiscal year 1936 (Washington, D.C., Government Printing Office, 1936), 101-102; Annual Report of the Surgeon General of the Public Health Service of the United States: for the Fiscal year 1940 (Washington, D.C., Government Printing Office, 1940), 114.

66 See for example, “Why I should Know About Tuberculosis and What I should Know,” NNHN 6(4) 1938: 16-19; “My Community – Its Assets and Liabilities in the Control of Tuberculosis,” NNHN 8(4) 1940: 12; “The Role of the Negro College in the Control of Tuberculosis,” NNHN 9(1) 1941: 31.

67 “Mrs. Fernandis Named to Head Health Week,” Baltimore Afro-American, March 11, 1933, 23; “Negro Health Week Program,” Augusta Herald, April 3, 1933, “THC, 1933,” 992, TA; “Lincoln, Neb,” Chicago Defender, April 6, 1935, 22; “Negroes to Open Health Campaign,” Macon Telegraph, March 31, 1935, “THC, 1935,” 646, TA; ”National Negro Health Week,” Brookhaven Leader, May 23, 1936, “THC, 1936,” 505, TA; “Negro Health Week to Feature Parade Here,” Spartanburg Herald, March 22, 1936, “THC, 1936,” 518; “Health Week for Negroes Planned,” 321

Lots of communities also increased their focus on changing black attitudes towards medical professionals. As nurse Mildred Washington explained, “Many people have thought of doctors and nurses as persons to call when they are ill, rather than a guide against getting ill; the same people have thought of the county or city health department as a quarantining board when epidemics break out…”68

Local NNHW leaders tried a number of tactics to combat misperceptions. In

Philadelphia, the city’s black Mercy and Frederick Douglass Hospitals hosted public health lectures on pre-natal care, birth control, and child rearing during NNHW. In addition to providing some health education, the purpose was to build better relationships between the medical community and the public.69 In Norfolk and Chicago, organizers worked to expand funding and services for hospitals and convalescent homes for those forced out of hospitals, but who had yet to recover.70 In St. Louis and Lincoln County,

Mississippi, NNHW committees held clinics for nurses, midwives, and social workers.

Tarboro Southerner, March 24, 1936, “THC, 1936,” 516, TA; “Negro Health Week to Start,” Charlotte Observer, March 29, 1936, “THC, 1936,” 515, TA; “Mrs. Fernandis Named to Head Health Week,” Baltimore Afro-American, March 11, 1933, 23; “Negro Health Week Program,” Augusta Herald, April 3, 1933, “THC, 1933,” 992, TA; “Prominent Leaders Jon Better Health Crusade,” Indianapolis Recorder, April 21, 1934, “THC, 1934,” 665, TA; “Negro Health Week Gets Active Support of T. B. Association,” Columbia State, March 30, 1934, “THC, 1934,” 679, TA; ; “Negro Health Week Observance Set for April 1 to 8,” San Antonio News, March 13, 1934, “THC, 1934,” 683, TA; “Committee on Health Will Fight Disease,” Houston Informer, March 30, 1935, “THC, 1935,” 670, TA; “Negro Health Week Will Be Observed Here,” Houston Chronicle, March 17, 1935, “THC, 1935,” 670, TA; “ ‘Perfect Boy’ Chosen During Health Week,” Philadelphia Tribune, April 9, 1936, 15.

68 Mildred Washington, “Negro Health Week Planned,” Waycross Journal-Herald, March 12, 1936, “THC, 1936,” 497, TA; “Plans Are Made on Health Week,” Macon Telegraph, March 26, 1936, “THC, 1936,” 499, TA.

69 “Mercy Doctors to Lecture on Birth Control,” Philadelphia Tribune, March 29, 1934, 16; “Plan ‘Medical’ Ball for Home, Two Hospitals,” Philadelphia Tribune, March 21, 1935, 20.

70 “National Negro Health Week,” Norfolk Journal and Guide, April 1, 1933, “THC, 1933,” 1014, TA; “Doctor Plans Home For Convalescents,” Chicago Defender, March 30, 1935, 4. 322

The idea was to make sure everyone had the same health information and coordinate the efforts of all health professionals during the Week.71

The issue of black health employment was so important that it was an area of focus at both the 1933 and 1934 NNHW Annual Conferences. The 1934 Conference led to a number of recommendations including the expansion of public health nursing staffs, use of dental hygienists to teach oral hygiene, and better education for black nurses and doctors.72 Under Brown, the NNHW Committee pushed these ideas in the years that followed.

Another new element to the Week, introduced at the grassroots level, was an increased emphasis on exercise. The growing numbers of people working in factories and offices instead of farms led both blacks and whites to worry about getting enough fresh air and exercise.73 Although Baltimore and a few other cities organized marathons and physical activities during NNHW, physical fitness was not a top priority. Baltimore’s

NNHW organizers moved the annual marathon to the end of April, several weeks after

NNHW. While still named the “Health Week marathon,” its separation from the Week’s activities made the connection with NNHW more symbolic than anything else. Reporters covering the race focused on winners and losers, not discussions of health. When Roscoe

71 “Institute and Clinic Will Be Features of Health Week Program,” St. Louis Argus, March 23, 1934, “THC, 1934,” 671, TA; “National Negro Health Week,” Brookhaven Leader, May 23, 1936, “THC, 1936,” 505, TA.

72 H. S. Cumming to “To the Cooperating Agencies,” September 25, 1933, “Health Week” Folder, Box 58, RMLC, TA; “”Annual Conference of the National Negro Health Week For the Year 1935 Observance,” NNHN, Vol. 2, No. 3, October-December, 1934, 1-22, especially 10-12.

73 These concerns started early, see for example “Scientific Exercise for Health,” The Survey 35(10) December 4, 1915: 273; “The Draft Law a Health measure,” The Survey 39(24) March 16, 1918: 657-658. 323

Brown attended the marathon as the principal speaker in 1933, the Baltimore Afro-

American only noted his role, not his words or message. Instead, the paper gave its column inches to the race’s competitiveness and trophy winners, muting the connection between the Week and black health.74

However, a few local NNHW organizers came to see engaging athletes in NNHW activities as a way to generate publicity and excitement for health messaging. As opposed to just promoting general health, the official NNHW sermon that Rev. F. Rivers Barnwell prepared for the 1935 Week emphasized recreation. He stressed the need for playgrounds and parks, and encouraged churches to build gymnasiums as ways to promote better health, noting that “The great apostle, St. Paul, loved games, races, and honorable conquest.”75 Since the church was still a significant influence in the Week from an organizing and publicity standpoint, Barnwell’s sermon put the church in the middle of this new health initiative. Activists for white ethnics and the poor had a similar emphasis to Barnwell, but leaned on the National Recreation Association.76

Alternatively, some local NNHW leaders turned towards athletes in the most popular sports of the 1930s to connect health and physical fitness. In 1935, Jesse Owens had made a name for himself at the Big Ten Championships. He broke five world records

74 “Edgar Lee Wins 9th Annual Marathon,” Baltimore Afro-American, April 29, 1933, 17.

75 F. Rivers Barnwell, “The Open Door of Health for Home and Community,” 1-3, March 31, 1935, folder 3, box 13, NNHW, TA. For comparison see for example, “The National Negro Health Week Sermon (1933),” N/A, March 23, 1933, “THC, 1933,” 1005, TA.

76 See for example Mabel Travis Wood, “America Gets on the Grass,” The Survey 60(2) April 15, 1928: 95-97. In the 1920s this group was named the Playground and recreation Association of America. 324 within an hour and earned the title “the fastest human in the world.”77 I. J. K. Wells, the

West Virginia State supervisor of Negro schools thought such a tremendous athlete would make a great NNHW contributor because, “Jesse Owens, being one of the finest specimens of physical health in the world…should be in a position to speak, with authority, concerning health and physical development.”78 Wells hoped that seeing and hearing Owens “will mean much to the development of health and physical fitness among our citizens.”79 Thus, Wells hoped to connect the concepts of health and fitness and generate more interest in NNHW with a celebrity that blacks cherished and even whites could appreciate.

Owens’ talks concentrated on medical issues instead of health practices. He emphasized the dangers of syphilis and tuberculosis and the need to see medical professionals for treatment. While he touched on the importance of drinking water, keeping clean, and the negative effects of alcohol, he provided little emphasis on the connection between physical activity and health other than saying “Encourage children to take part in games and to join clubs that will keep them healthy and give them body- building exercises.”80 As the title of the Baltimore Afro-American article illustrated,

“Syphilis, T.B. Our Worst Enemies,” was the focus and center of Owens’ message.

77 “Jesse Owens Invades West Virginia On Speaking Tour,” Chicago Defender, March 14, 1936, 14.

78 “Jesse Owens Invades West Virginia On Speaking Tour,” Chicago Defender, March 14, 1936, 14.

79 “Jesse Owens Invades West Virginia On Speaking Tour,” Chicago Defender, March 14, 1936, 14. 80 “Syphilis, T.B. Our Worst Enemies, Says Jesse Owens in Radio Speech,” Baltimore Afro-American, April 4, 1936, 3. 325

It is hard to assess the degree of success or engagement that Owens and other athletes generated.81 Some schools included a field day, discussion of proper exercise techniques, or even a doctor’s lecture on the topic of physical fitness, but it is unclear the degree to which such activities were a result of celebrity athlete endorsements.82 However, the emphasis on fitness did reflect how the USPHS could use NNHW to support government health priorities as the Roosevelt Administration championed the idea of a fit workforce.83

While the News, physical fitness, and greater medical establishment support were all alterations or expansions to the Week, the PHS left other elements of NNHW unaltered.

Local organizers maintained the flexibility regarding the dates and day-to-day activities of their participation.84 Although the NNHWC did not include a discussion of best health practices in the bulletin, they appeared elsewhere, though in less detail. The 1934 NNHW poster and leaflet featured an acrostic poem of six tenets towards good health, “A Daily

Half Dozen,” similar to the “A Daily Dozen” health tips in the 1927 bulletin. Although the poster advised seeing a doctor and dentist, it also stressed proper nutrition, rest,

81 Lincoln University had New York state amateur boxing champion Meyer Rowan speak at its 1935 NNHW campaign, see “N.Y. Boxer Ends Tour,” Baltimore Afro-American, April 27, 1935, 21.

82 “Parade Climaxes Observance of Negro Health Week,” Alexandria Town Talk, April 3, 1935, “THC, 1935,” 652, TA; “Health Week is Observed Here by Negro Children,” Baton Rouge Times, March 30, 1935, “THC, 1935,” 654, TA; “Successful Health Week Program at Cumberland T.S.,” Norfolk Journal and Guide, April 11, 1936, “THC, 1936,” 516, TA; “Negro Health Week Extended,” Macon Telegraph, April 6, 1936, “THC, 1936,” 494, TA; Loera Branch, “Germantown News,” Philadelphia Tribune, April 9, 1936, 10; “Health Week Is Observed at CCC Camp,” Washington Tribune, April 7, 1936, “THC, 1936,” 488, TA.

83 McBride, From TB to AIDS, 85, 92.

84 “Annual National Negro Health Week Conference for the Year 1933 Observance,” NNHN 1(1) 1933: 12; “Negro Health Week Any Week,” American Journal of Public Health Nations Health (AJPH), 26(6) 1936: 639-648, 641. 326 cleanliness, and fresh air.85 However, unlike the 1927 bulletin, it included only vague information about how to achieve these goals. For instance, the 1927 bulletin explained that eating well meant, “More milk, greens, and fresh fruits; less sweets, meats, and eggs,” but the 1934 poster simply advised, “Eat proper food,” with no elaboration or examples.86 Locally, nutrition and proper diet received a lot of emphasis, as did access to better food and water.87 Screening homes and basic health education and cleanup also remained important activities, since white and black health authorities both agreed that, as the Houston Informer put it, “Beauty means health.”88

The growing interracial work that occurred throughout the country in the 1930s continued to be a focus of the Week as well. While white politicians often used the campaign to curry favor with black voters, their statements of support created more publicity to spur NNHW programs.89 Many newspaper reports made special mention of

85 “National Negro Health Week Twentieth Anniversary,” folder 6, box 11, NNHW, TA; “National Negro Health Week Twentieth Anniversary,” folder “T27.2:N31/2 through N31/3/938,” box T702, RG 287, Publication of the Federal Government, NARA II.

86 “National Negro Health Week: April 3 to 10, 1927,” PHS, Washington, D.C., 1927, ii, folder 1032, box 132, RMGC, TA; “National Negro Health Week Twentieth Anniversary,” folder 6, box 11, NNHW, TA.

87 See for example: “Dietetic Committee and Negro Health Week,” St. Louis Argus, April 13, 1934, “THC, 1934,” 671, TA; “Need for Negro Health Week,” Macon Telegraph, March 31, 1935, “THC, 1935,” 646, TA; “Lupkins, Texas,” Chicago Defender, April 20, 1935, 19.

88 “Kansas City Gets Health Award Again,” Kansas City Call, July 21, 1933, “THC, 1933,” 1001, TA; “Parade Climaxes Observance of Negro Health Week,” Alexandria Town Talk, April 5, 1935, “THC, 1935,” 652, TA; “Negro Health Week in City is Success,” Alexandria Town Talk, April 15, 1935, “THC, 1935,” 653, TA; “Health Week,” Millen News, March 26, 1936, “THC, 1936,” 499, TA; “Significance of National Negro Health Week,” San Antonio Express, March 29, 1936, “THC, 1936,” 526, TA; “Health Week,” Houston Informer, March 30, 1935, “THC, 1935,” 670, TA. For the white perspective, see for example Virginia R. Wing, “The Beauty Motif,” The Survey 59(4) November 15, 1927: 207-210, 207.

89 Harry W. Nice, “Governors Proclamation Designating Sunday, March 31, 1935, to Sunday, April 7, 1935, as National Negro Health Week,” Baltimore Afro-American, March 9, 1935, 20; “N.J. Governor Signs Health Week Edict,” Baltimore Afro-American, March 30, 1935, 2; 327 the participation of whites, especially white physicians.90 In addition to cooperating with the NTA’s national campaign for early TB diagnosis, local NNHW committees combined their work with other campaigns, such as community clean-up weeks, or National Child

Health Week.91 In 1934, the NNHM Committee allied with the National Society for the

Prevention of Blindness to focus on eye care.92 By 1934, the number of agencies supporting NNHW nationally had grown 25% to 45.93

The content of the NNHW’s standard radio address, designed for grassroots organizers to read on local stations, also contained an interracial concentration. Under

Brown’s thumb, it described NNHM as “a year-round program which undertakes to keep the Negro population race health conscious and to effect interracial understanding and

“Health Week Committee Gets Merit Certificate; Other News of Trenton,” Philadelphia Tribune, January 2, 1936, 13; W. Thomas Watson, “New Jersey Governor Has Race Attache,” Chicago Defender, April 24, 1937, 4; “Official Health Week,” Baltimore Afro-American, March 30, 1935, 4. For more on the interracial movement in health, see Samuel Kelton Roberts, Jr., Infectious Fear: Politics, Disease, and the Health Effects of Segregation (Chapel Hill, NC: University of North Carolina Press, 2009), especially 63.

90 See for example: “Reading,” Baltimore Afro-American, April 8, 1933, 14; Trago T. McWilliams, “Lincoln, Neb,” Chicago Defender, April 20, 1935, 20; “Mass Meeting is Climax to Health Week Observance,” Norfolk Journal and Guide, April 13, 1935, “THC, 1935,” 676, TA; “Need for Negro Health Week,” Macon Telegraph, March 31, 1935, “THC, 1935,” 646, TA; “Negroes to Open Health Campaign,” Macon Telegraph, March 31, 1935, “THC, 1935,” 646, TA; Trago T. McWilliams, “Lincoln, Neb.,” Chicago Defender, April 20, 1935, 20.

91 “Health Week is Observed Here by Negro Children,” Baton Rouge Times, March 30, 1935, “THC, 1935,” 654, TA; “Negro Health Week,” Salisbury Post, March 24, 1935, “THC, 1935,” 660, TA; “Prominent Leaders Join Better Health Crusade,” Indianapolis Recorder, April 21, 1934, “THC, 1934,” 665, TA.

92 “16,000 Blind in the U.S.,” Baltimore Afro-American, March 31, 1934, 15; Louis Resnick, “Remember Eye Hazards as Health Week Begins,” Baltimore Afro-American, April 7, 1934, 5; “Prevention of Blindness,” San Antonio News, March 29, 1934, “THC, 1934,” 683, TA.

93 “Negro Health Week to be Observed Here,” Greensboro News, March 30, 1934, “THC, 1934,” 674, TA. 328 team-work.”94 While Tuskegee’s leaders had seen the Week as having the ancillary benefit of improved interracial cooperation, its goal had been to provide blacks with health practices they could apply. For Brown, efforts to get the two races to work together, combined with improving black perceptions and use of the medical establishment, were the primary objectives.

To make the interracial aspects of NNHW and its health program clearer, Brown embraced the concept of one race, i.e., the human race, and chose speakers and topics with this concept in mind. Cumming’s address “What Home Means to Me,” contained nothing about race. He never referred to blacks by this or any other name, just to “the

American people” and “American standards of living.”95 Estella Warner of the Office of

Child Hygiene Investigations within the PHS gave the 1936 address on “The Child and the School as Factors in Community Health.” While she gave a general overview of

NNHW and its history, she too left race out of her discussion, focusing instead on the ways in which schools could promote healthy children and a healthy community.96 This omission of specific racial issues made it easier to identify similarities in health concerns across races, promoting more interracial work. It also subtly challenged Jim Crow segregation. If both races could use the same strategies to improve their health, and if they faced similar issues, there was little reason to separate them.

94 “Twenty Years After in Negro Health,” 2, March 15, 1934, Folder 6, Box 11, NNHW, TA.

95 Hugh S. Cumming, “What Home Means to Me,” 1-3 but especially 1, March 15, 1935, folder 3, box 13, NNHW, TA.

96 Estella Ford Warner, “The Child and the School as Factors in Community Health,” 1-4, March 1, 1936, folder 1, box 8, NNHW, TA. The only time race is mentioned is on page 4 when she refers to the school shaping “the future of the race,” but in the context in which she says it, “the race” seems to be Americans. 329

Although the NNHM Committee tried to keep NNHW above the political fray,

African Americans still saw the Week as an arm for racial uplift. They asserted that economic and educational equality, as well as decreasing racial restrictions on municipal services, including sanitation and hospital access, would all improve black health. While in agreement on the issues facing the race, communities differed on the pathways to overcome these barriers. Some lashed out. The Norfolk Journal and Guide used the

NNHW platform to characterize inequalities in economics, education, and municipal services as “criminally negligent.”97 Others, such as the Houston Informer, argued that

African Americans could only overcome these obstacles through the extension of the franchise. The paper called for a National Negro Vote Week to follow NNHW to register black voters and give them power to demand that elected leaders support legislation ending the white primary in Texas, and funding to support black education, health and general improvement of black communities.98

The forum that local NNHWs offered to entertain a variety of African American concerns encouraged the NAACP to take a more active role in the Week. As Du Bois became more interested in black separatism in the early 1930s, he began to get into disputes with other NAACP leaders, eventually leading to his resignation from The Crisis and the NAACP on July 1, 1934. Du Bois’ disagreements coincided with increased

NNHW coverage in The Crisis.99 Three months after Du Bois left, The Crisis published

97 “Va. Negligent About Health of the Negro,” Norfolk Journal and Guide, April 11, 1936, “THC, 1936,” 529, TA.

98 “Health Week,” Houston Informer, April 4, 1936, “THC, 1936,” 524, TA.

99 See for example, “Along the Color Line,” The Crisis, April 1930, 131; “Along the Color Line,” The Crisis, May 1931, 163; “Along the Color Line,” The Crisis, April 1934, 103. 330 its first long article on NNHW when it examined the work of Kansas City’s Health

Week.100 More significantly, the following year Walter White, Executive Secretary of the

NAACP, appeared as a guest on a radio broadcast promoting NNHW.101 The publicity and support that NAACP leadership gave to the Week trickled down to its local branches.102

The marriage between the campaign and NAACP stemmed from their mutual interest in promoting racial parity where the law required segregation. During the 1930s, the

NAACP began filing antidiscrimination lawsuits in the South. These lawsuits combined with national support for black health, such as the PHS’ NNHW program, to push some

Southerners to start to equalize public services in sectors such as health. In NNHW, this push for racial parity manifested itself in the campaign’s encouragement of more opportunities for black medical professionals. In the 1930s, integration was a step too far.

The goals of 1930s black health reformers concentrated on equalizing access to health care, having a proportional number of physicians and hospitals based on the population.103 Equal access did not challenge segregation, making it an issue whites were

100 L. Herbert Henegan, “Keeping Well Babies Well,” The Crisis, October, 1934, 297, 306.

101 “Bledsoe and White with Southernaires, April 7,” Baltimore Afro-American, March 30, 1935, 9.

102 “Club Presents Kiddies in Concert at Media,” Philadelphia Tribune, April 11, 1935, 12; Buddy Edwards, “Media,” Baltimore Afro-American, April 13, 1935, 18; “National Negro Health Week Set,” Salt Lake City Tribune, March 30, 1935, “THC, 1935,” 673, TA; “Mammoth Health Week Program is Launched,” Chicago Defender, March 28, 1936, 6; “Oregon: Portland, Ore,” Chicago Defender, April 13, 1935, 19.

103 Karen Kruse Thomas, “The Hill-Burton Act and Civil Rights: Expanding Hospital Care for Black Southerners, 1939-1960,” Journal of Southern History 72(4) November 2006: 832-870, 829-840. 331 more likely to support. It would also certainly help improve black health since the 3,805 black physicians in 1930 represented just 2.4% of all physicians.104

The NAACP supported this pragmatic philosophy in promoting the equal distribution of federal money to black and white Southern schools. As the historian Karen Kruse

Thomas explains, in the early 1940s the NAACP’s pragmatism led it to lobby “against stronger nondiscrimination clauses.”105 The NAACP worried that these kinds of policies

“would kill beneficial legislation.”106

The role of women in the Movement also continued to grow during the early to mid-

1930s. The work of the National Association of Colored Women (NACW), nursing groups, and the many other women’s groups and individuals who organized the Week at the grassroots level all made the NNHM Committee take notice of the importance of women to the Movement. In the past, the Week’s organizers had recognized the contributions of NNHW efforts women led, and had even made women judges in the national NNHW competition. However, neither the Week’s Committee, nor that of the

NNHM, included any women.

104 U.S. Bureau of the Census, Fifteenth Census of the United States: 1930 – Population: General Report on Occupations (Washington, D.C.: U.S. Department of Commerce, 1933), 84. David McBride cites 3,770 black doctors. See David McBride, Caring for Equality: A History of African American Health and Healthcare (Lanham, MD: Rowman & Littlefield, 2018), 66. This figure is based off of W. Montague Cobb, “Progress and Portents for the Negro in Medicine,” The Crisis April 1948: 107-122, 108.

105 Thomas, “The Hill-Burton Act and Civil Rights,” 829-840. Quote is from page 840 and italics are in the original. See also Charles C. Bolton, “Mississippi’s School Equalization Program, 1945-1954: A Last Gasp to Maintain a Segregated Education System,” Journal of Southern History 66(4) November 2000: 781-814, 782.

106 Thomas cites as an example a 1943 bill to federally subsidize teacher pay. Thomas explains that the NAACP argued against strengthening the nondiscrimination clauses for fear that the bill would not get passed. She also suggests the NAACP used the same rationale for supporting the Hill-Burton Act. See Thomas, “The Hill-Burton Act and Civil Rights,” 840, 834. 332

Under Brown, the Week began to include more women. The second issue of the 1935

News featured an article by Mrs. M. M. Hubert titled “Club Women’s View of National

Negro Health Week.”107 Hubert explained that the reason why women were so invested in the Week was that, “…the mother is the force which influences and controls the child and that the home is the seat of that influence.”108 This insight helps explain why, while the responsibilities women had on local committees varied, they often organized cleanups and baby contests.109 Although Hubert spoke for club women, the concept of the mother as home health leader pervaded America regardless of class or race. With the support of the NACW and the growing participation of women, the NNHM Committee expanded to include its first woman, Mabel Keaton Staupers. Her position as Executive director of the

NACGN made her part of the medical establishment and a logical choice to join the

NNHM Committee. Her work with the Federal Council of the Churches of Christ’s

Church Women’s Committee on Race Relations also gave her valuable experience working on public health campaigns. Yet her selection also emphasized not only the importance of nurses, but of all women in NNHM.110

107 M. M. Hubert, “Club Women’s View of National Negro Health Week,” NNHN 3(2) 1935: 3-5.

108 M. M. Hubert, “Club Women’s View of National Negro Health Week,” NNHN 3(2) 1935, 3.

109 “State of Tennessee Department of Institutions Welfare Division,” Nashville Globe, April 24, 1933, “THC, 1933,” 1010, TA; “Negro Health Week Observance Set for April 1 to 8,” Albany Herald, March 30, 1934, “THC, 1934,” 663, TA.

110 “Preliminary National Negro Health Week Announcement for the Twenty-first Annual Observance: Sunday, March 31, to Sunday, April 7, 1935,” (Washington, D.C.: U.S. Public Health Service, 1935), 1, T 27.2: N31 935 prelim, Box T702, “Publications of the Federal Government,” RG 287, NARA II; Bettye Collier-Thomas, Jesus, Jobs, and Justice: African American Women and Religion (New York, NY: Knopf, 2010), 339-340. 333

1935 was also the first year that Tuskegee did not participate in planning NNHW.

Monroe Work’s decision to leave the Week may have been a long time coming as geography, combined with his Tuskegee responsibilities and lack of medical expertise in a campaign that increasingly relied on medical professionals, would have limited his influence. Additionally, once the Week was under the auspices of Howard University,

Tuskegee Institute as a whole took less interest in the campaign. Moton too did not attend meetings and the Week stopped appearing in the principal’s annual reports on the

Institute. Regardless, by the start of 1935, Tuskegee’s influence on the campaign had ended and the NNHW Committee now contained three medical experts and two lay people, giving the medical professionals their first leadership majority.111

Assessing the PHS’ NNHW Campaign: 1933-1936

The publication of the News made it much easier to track and assess NNHW participation. While the NNHW Committee had included tracking sheets with the bulletins of the late 1920s, the News provided the easiest way to ensure feedback. It targeted professionals, especially those in health likely to organize or participate in local

Weeks. The News included the Week’s report sheet so that these leaders could easily track participation. Since these report sheets included the exact categories and types of activities that Brown and the NNHM wanted to track, it made it easier to organize

NNHW data. These sheets also suggested the work that the NNHM Committee wanted

111 1935 NNHW Committee: Roscoe Brown (Chairman), R. Maurice Moss (Secretary), F. Rivers Barnwell, Algernon Jackson, Mabel Keaton Staupers. “National Negro Health Week, Twenty-first Annual Observance: Sunday, March 31, to Sunday, April 7, 1935,” PHS, Washington, D.C., 1935, 1, folder 3, box 13, NNHW, TA. There was little ceremony in Work’s retirement, the 1934 conference notes included one sentence on his contributions. See “Annual National Negro Health Week Conference For the Year 1935 Observance,” NNHN 2(3) 1934: 4-5, 9. 334 done during the Week, helping to curtail certain grassroots efforts from going too far astray of the Committee’s goals. The data indicated significant growth in the Week under

PHS leadership. From 1933-1936, the number of communities participating increased from 1,652 to 2,500, as did the total attendance for all NNHW activities each year. A further examination of the data explains the ways in which the PHS shaped this growth and its priorities.112

Under the PHS, the Week continued to support the original NNHW efforts of cleaning up the neighborhoods, but between 1933 and 1936 the methods and focus of these cleanups changed. Communities continued to clean up homes and lots, fight pests, and build and improve outhouses. However, the emphasis on community cleanup activities that had dominated the early years of the Week disappeared. The number of planting and flower projects the Week’s leaders organized decreased by more than one- third, and the number of general cleanup activities outside of homes and lots decreased by 28.7%.113 Instead of providing participants with health practices to implement, there was a greater focus on reaching more people and educating them directly about health.

In terms of publicity, PHS embraced the media on a scale the Week had never seen before. Connections between state and local health officers and newspaper editors led the number of newspaper articles on NNHW to almost double between 1933 and 1936. New

112 “Statistical Report: National Negro Health Week - 1933,” NNHN 1(2) 1933: 2-3; “Statistical Report: National Negro Health Week - 1934,” NNHN, 2(2) 1934: 2-3; “Statistical Report: National Negro Health Week - 1935,” NNHN 3(3) 1935: 2-3; “Statistical Report: National Negro Health Week - 1936,” NNHN 4(3) 1936, 2-3.

113 “Statistical Report: National Negro Health Week - 1933,” NNHN 1(2) 1933: 2-3; “Statistical Report: National Negro Health Week - 1934,” NNHN, 2(2) 1934: 2-3; “Statistical Report: National Negro Health Week - 1935,” NNHN 3(3) 1935: 2-3; “Statistical Report: National Negro Health Week - 1936,” NNHN 4(3) 1936, 2-3. 335 media had an even greater impact on the Week’s publicity. The proliferation of radio led to a 332.7% increase in Health Week broadcasts on the air waves in 1936 over 1933.

Radio had the same ability as a lecture to reach a large number of people, but without the organizational difficulty of finding a lecture hall and publishing and distributing fliers to promote attendance. The use of films during the Week also increased substantially. Here, the popularity of the medium combined with the PHS’ influence to get movies to organizers. Local and State Health Departments had greater access to health movies than most community organizers because these departments had access to the archives of all government agencies, such as the PHS and the Children’s Bureau. Additionally, partnerships with the NTA, Red Cross, American Social Hygiene Association, and other health groups gave NNHW leaders access to the films these organizations produced. The upshot was that the number of films shown during the Week in this period more than tripled and attendance more than doubled. These films were also useful to the medical establishment who could control the presentation of health messages since this group oversaw the production of the vast majority of these pictures. Lastly, the medium allowed local leaders to show the films repeatedly to ensure the greatest possible audience. And as a popular form of entertainment, organizers often combined movies with speakers as a way to break up the relatively boring lectures.114

All the publicity and increased use of media led to a growth in the number of reports received and revealed a definite increase in participation. In 1933, the total attendance for

114 “Statistical Report: National Negro Health Week - 1933,” NNHN 1(2) 1933: 2-3; “Statistical Report: National Negro Health Week - 1934,” NNHN, 2(2) 1934: 2-3; “Statistical Report: National Negro Health Week - 1935,” NNHN 3(3) 1935: 2-3; “Statistical Report: National Negro Health Week - 1936,” NNHN 4(3) 1936, 2-3. 336 all NNHW campaigns submitting reports was 475,052. In 1936, it was 723,950. These numbers probably overstate the number of people receiving health information since the attendance figures likely include people who attended multiple events. On the other hand, many communities still did not report their participation, and the figures, by any measurable standard, reflect substantial growth in turnout. 115

The New Deal and African American Well-being and Uplift

In order to better understand black health issues during the 1930s and the way in which African Americans participated and interacted with the Week’s health messages, it is important to remember the political, economic, and social situation they faced during this period. When Franklin Roosevelt took the Presidential oath in 1933, he inherited the worst economic crisis the U.S. had ever seen. Unemployment had risen to 25%, and 30% of banks had closed. Roosevelt’s response to this economic crisis was to have the government spend money to provide relief for the needy in the form of work and financial aid, and to have Congress enact laws to reform the financial sector and jumpstart the economy. Roosevelt’s New Deal legislation required record amounts of government spending, hiring, and involvement in the fabric of American life as the nation moved from a hands-off to a hands-on government. This massive change had the potential to provide opportunities, political and economic, to those the government often overlooked, including African Americans.

115 “Statistical Report: National Negro Health Week - 1933,” NNHN 1(2) 1933: 2-3; “Statistical Report: National Negro Health Week - 1936,” NNHN 4(3) 1936, 2-3. 337

Historians of the New Deal have long-debated the impact of New Deal legislation on

African Americans, as well as the degree to which black interests and goals factored into

New Deal initiatives. As part of its attempt to turn the country around, the Roosevelt administration tripled the number of blacks working in the federal government, creating a new group of black professionals and administrators as race relations advisors in New

Deal programs. This Black Cabinet advised the President about African American issues and worked to ensure that blacks received equal treatment and participation in New Deal programs. President Roosevelt’s judicial appointees to the Supreme Court ruled against the use of all white juries in cases with black defendants and against police use of physical or mental torture. The NAACP often brought these civil rights issues to court, and these rulings gave it greater publicity and led to the creation of other black groups that promoted civil rights and pushed for black voter registration in the South. The

President’s wife, Eleanor Roosevelt, promoted interracial work. She worked with the

NAACP on a number of issues, such as anti-lynching laws, and helped to organize the

Southern Conference for Human Welfare, which established an interracial forum to discuss segregation and black inequality.116

On the other hand, President Roosevelt still needed Southern Democratic congressmen to support the New Deal legislation he proposed. This political concern, combined with his lack of investment in black civil rights, caused him not to support a

116 Nancy Weiss, Farewell to the Party of Lincoln: Black Politics in the Age of FDR (Princeton, NJ: Princeton University Press, 1983), 132-135; Patricia Sullivan, Days of Hope: Race and Democracy in the New Deal Era (Chapel Hill, NC: The University of North Carolina Press, 1996), 100, 134; Harvard Sitkoff, A New Deal for Blacks: The Emergence of Civil Rights as a National Issue, Volume I: The Depression Decade (New York, NY: Oxford University Press, 1978), 73-78, 230-243, 294; Robert McElvaine, The Great Depression: America, 1929-1941, 25th Anniversary ed. (New York, NY: Three Rivers Press, 2009), 194. 338 federal anti-lynching law and to keep his distance from most efforts directly aimed at racial equality. The President’s lack of support limited the impact of such attempts.117

Additionally, historians Daniel Kryder and Nancy Weiss argue that while the Roosevelt administration hired a greater number of African Americans, the Black Cabinet was more racial window dressing than anything else. Its job consisted mainly of collecting data on racial inequality and presenting it to the chiefs of various departments who then decided what to do with the information. Without a directive from the Administration on racial equality, the department chiefs varied in their application of the data, or did not use it at all. Finding few receptive ears among their superiors, some in the Black Cabinet leaked stories to the press in the hope that public pressure would force changes in practices.118

Such treatment questions the influence and role African Americans had within the

Administration.

The New Deal laws had a mix of effects on African Americans. The government distributed relief payments unequally by race, especially in the South where blacks received 70% less than whites in some areas. The Agricultural Adjustment Act mandated farmers cut cotton production by 40%. This policy directly affected Southern blacks because many worked as tenants for white landholders. Less production meant farmers needed fewer tenants and sharecroppers, leading to mass evictions. The National

Recovery Administration (NRA) was also discriminatory. The NRA established a policy of equal pay regardless of race. However, it excluded Southern cotton mills and most

117 Sitkoff, A New Deal for Blacks, 136-137, 274-303; Weiss, Farewell to the Party of Lincoln, 163-167.

118 Weiss, Farewell to the Party of Lincoln, 74-79, 147; McElvaine, The Great Depression, 194; Daniel Kryder, Divided Arsenal: Race and the American State During World War II (New York, NY: Cambridge University Press, 2000), 27. 339 domestic and unskilled laborers, low wage jobs relegated to most blacks. Many companies opted to pay a fine and hire whites rather than follow the NRA equal pay policy. The Social Security Act’s exclusion of domestic and agricultural employees from unemployment compensation and old-age insurance made it difficult for many African

Americans to find relief.119

Other legislation had the effect of promoting African American interests. The Works

Progress Administration (WPA), the Civilian Conservation Corps (CCC), and National

Youth Administration (NYA) all provided opportunities for black employment, albeit for low wages. The historian Lizabeth Cohen argues that when blacks reported issues of discrimination in these programs, the government acted “in a surprising number of cases.”120 For example, when the NAACP protested the underrepresentation of blacks in the California NYA, the NYA created a Negro Division in the state. Such interventions encouraged African Americans to pursue their interests as groups supporting the race grew in strength and number. The NYA eventually created a Division of Negro Affairs, and the Roosevelt administration appointed Mary McLeod Bethune as its Director. From this position, Bethune reached out to black youth to promote education through various school programs.121

119 McElvaine, The Great Depression, 189-190; Sitkoff, A New Deal for Blacks, 47-55; Weiss, Farewell to the Party of Lincoln, 163-167; Colin Gordon, Dead on Arrival: The politics of Health Care in Twentieth-Century America (Princeton, NJ: 2003), 185.

120 Lizabeth Cohen, Making a New Deal: Industrial Workers in Chicago, 1919-1939 (New York, NY: Cambridge University Press, 1990). See also Cheryl Lynn Greenberg, “Or Does It Explode?”: Black Harlem in the Great Depression (New York, NY: Oxford University Press, 1991), 153.

121 Douglas Flamming, Bound for Freedom: Black Los Angeles in Jim Crow America (Berkeley, CA: University of California Press, 2005), 343-347. 340

New Deal policies also strengthened African American labor in the North. The

Wagner Act’s guarantee of the right to unionize, collectively bargain, and strike made forming a union and increasing union membership easier for the working class.

Unintentionally, the Act caused African American union membership to increase as unions reached out to blacks to strengthen union numbers. The law also encouraged blacks to organize unions for themselves. The Brotherhood of Sleeping Car Porters, headed by A. Philip Randolph, quickly established itself as the largest predominately black labor union in the country. Its status allowed it to work with the NAACP and Urban

League to pressure the federal government for greater racial equality in hiring. This bitter struggle eventually led to the creation of the Federal Employment Practices

Commission.122 Overall, most historians agree that, regardless of the intent of New Deal legislation, these laws helped convince African Americans to support the Democratic

Party in the 1930s. Blacks saw opportunity and concern for the race in the laws passed.123

In the field of health, New Deal legislation also had a significant impact on African

Americans. The Social Security Act included funding to strengthen and expand existing state and local health organizations. The WPA, in addition to running a number of hiring programs, also expanded government relief efforts, provided school lunches to young

122 Cohen, Making a New Deal, 331-337; Joe William Trotter, Jr., Black Milwaukee: The Making of an Industrial Proletariat, 1915-1945 (Chicago, IL: University of Illinois Press, 1985), 160-211; Flamming, Bound for Freedom, 357-361; St. Clair Drake, Black Metropolis: A Study of Negro Life in a Northern City (New York, NY: Harcourt, Brace and Company, 1945), 314-341.

123 See for example: Sitkoff, A New Deal for Blacks; Weiss, Farewell to the Party of Lincoln; McElvaine, The Great Depression; Trotter, Jr., Black Milwaukee; Cohen, Making a New Deal; Greenberg, “Or Does It Explode?”; Sullivan, Days of Hope; Kryder, Divided Arsenal; Flamming, Bound for Freedom; Lauren Sklaroff, Black Culture and the New Deal: The Quest for Civil Rights in the Roosevelt Era (Chapel Hill, NC: The University of North Carolina Press, 2009). Prior to the 1930s, most African Americans who voted supported the Rpublican Party, mostly out of loyalty to Abraham Lincoln and the Republicans of the 1860s who were responsible for emancipation. 341 children in need, and helped increase the number of hospital beds nationally by 120,000.

And the Farm Security Administration provided low cost medical care to its clients regardless of color. Although not specifically targeting blacks, African Americans felt the benefits of these campaigns as the expansion of health services came with increased access for all.124 In terms of direct impact, the Public Works Administration (PWA) built and financed more than 8,000 hospital beds for blacks and the WPA and Children’s

Bureau studied TB, venereal disease, and infant mortality in the black community.125

The NNHW campaign reflected some of the effects of these New Deal policies, and the general perception of a government more sensitive to concerns about racial equality.

The NNHW’s annual meetings included discussions of New Deal legislation. The

Committee commended the creation of the NRA and passed a resolution declaring its support for both a minimum wage and laws to prevent discrimination. The Committee argued that minimum wage laws and business practices were under the purview of health.

The Committee asserted that a minimum wage would guarantee some modicum of proper health, noting that poor housing and undernourishment made people more susceptible to disease. Pay equality ensured that all workers benefit from a wage increase, which would support the health of all employees. The NNHWC even successfully lobbied the NRA to

124 Bess Furman, A Profile of the United States Public Health Service, 1798-1948 (Bethesda, MD: U.S. Department of Health, Education, and Welfare, 1974), 396-397; Reynolds Farley, Growth of the Black Population: A Study in Demographic Trends (Chicago, IL: Markham Publishing Co., 1970), 7, 12, 227; Beardsley, A History of Neglect, 116, 158-159; Gunnar Myrdal, An American Dilemma: The Negro Problem and Modern Democracy (New York, NY: Harper & Brothers Publishers, 1944), 345; John C. Burnham, Health Care in America: A History (Baltimore, MD: The Johns Hopkins University Press, 2015), 255-256; Thomas, “The Hill-Burton Act and Civil Rights,” 828-830.

125 McBride, From TB to AIDS, 115-120. 342 appoint an NNHW representative so that it could participate in the discussion of the relationship between business and health.126

New Deal administrators also promoted the NNHW/NNHM (collectively, NNHWM) campaigns. In addition to conducting its own health program, a number of CCC camps organized and participated in the NNHW campaign. Just like all NNHW campaigns, the

CCC camps had speeches at churches, lectures from physicians, clinics, health surveys, and an emphasis on cleaning up.127 This nascent cooperation between New Deal organizations and the NNHW gained momentum when Roosevelt appointed a new

Surgeon General in 1936.

Surgeon General Thomas Parran

On April 6, 1936, Thomas Parran Jr. succeeded Hugh Cumming to become Surgeon

General of the PHS. Parran had spent his entire career in public health and served under

Franklin Roosevelt as state health commissioner when Roosevelt was Governor of New

York. Much of Parran’s experience was in the field of venereal disease, and he helped organize the Tuskegee Syphilis Experiment. However, he also tried to fight the stigma

126 “Annual National Negro Health Week Conference For the Year 1935 Observance,” NNHN 2(3) 1934: 21-22; “Annual National Negro Health Week Conference For the Year 1934 Observance,” NNHN 1(3) 1933: 12-13. Roscoe Brown was eventually elected as an Associate Member of the Joint Committee on National Recovery.

127 “Health Week Is Observed at CCC Camp,” Washington Tribune, April 7, 1936, “THC, 1936,” 488, TA; G. Lakes Imes, “Negro Boys in the CCC,” NNHN 4(2) 1936: 14-15. For more on the CCC’s health campaign, see Rachel Louise Moran, Governing Bodies: American Politics and the Shaping of the Modern Physique (Philadelphia, PA: University of Pennsylvania Press, 2018), 38-63. 343 against people with this disease, and was one of the early leaders to portray venereal diseases as a public health concern rather than a morality issue.128

Predictably, one of Parran’s first decisions as Surgeon General was to organize a national program against syphilis, which he characterized as “the most urgent public health problem in this country today.”129 Health officials estimated that during the mid-

1930s, as many as 683,000 people had syphilis at any given time. The disease was so pervasive because, as historians Bonnie Bullough and George Rosen explain, “The approaches that combined education with medical treatment, which were successful against tuberculosis and other nineteenth-century scourges, did not work well with the

STDs because of the stigma attached to sexual activities and a belief by many Americans that the victims deserved to suffer.”130 The disgrace associated with having the disease led many to conceal it from their friends and family and even physicians, making it particularly difficult to track. A 1935 study found 518,000 new cases that year, but Parran asserted that another 518,000 cases likely went unreported or unrecognized.131

While the campaign targeted all Americans, the Surgeon General argued that the disease presented specific challenges to African Americans since the race appeared

128 “New Surgeon General Plans Vigorous Health Program,” NNHN 4(1) 1936: 1.

129 Thomas Parran, Shadow on the Land: Syphilis (New York, NY: Reynal & Hitchcock, 1937), 52.

130 Bonnie Bullough and George Rosen, Preventive Medicine in the United States, 1900- 1990: Trends and Interpretations (Canton, MA: Science History Publications/USA, 1992), 53. While the authors wrote “STD” they meant STI.

131 Carter Godwin Woodson, The Negro Professional Man and the Community: With Special Emphasis on the Physician and the Lawyer, 1934, Reprint (New York, NY: Negro Universities Press, 1969), 102; Parran, Shadow on the Land, 54, 247-248. The Baltimore Health Department also estimated that only half of syphilis cases got reported, “The Costliest,” The Survey 71(3) March 1935, 84. 344 particularly susceptible to it. Studies at the time suggested that their rate of contraction was six times that of whites, and that black women remained infectious 2.5 times longer than white women.132 These so-called health statistics, involving racist assumptions and fed into racist tropes that blacks were inherently different from, and more promiscuous than, whites. However, Parran recognized that environmental and economic factors contributed to poor black health and the spread of syphilis in particular. This understanding led him to note that “Wherever education and living conditions among the negro race approximate that of the white race, the syphilis rate approximates that of the white.”133

Problematically, the Great Depression exacerbated the poor living conditions African

Americans faced. In Detroit, a late 1930s study found 34% of black dwellings unfit or in need of repair compared to only 6% of those for whites. Similar studies in Harrisburg,

Norfolk, and Savannah discovered 73%, 25%, and 55% of the black population in those respective cities living in similar conditions. Studies of Chicago, Detroit, Cleveland, St.

Louis, and Philadelphia found more than 20% of black families living in homes which did not have a dedicated toilet, compared to about 10% of whites. A three-story rowhouse might contain 20 families using seven water closets. In the South, 16% of black families in urban areas had two or more people per room, as opposed to 6% of whites.134 The

132 Parran, Shadow on the Land, 62-63, 176; Farley, Growth of the Black Population, 12, 223; Beardsley, A History of Neglect, 22.

133 Parran, Shadow on the Land, 177. For more on reasons for the statistical disparities in syphilis studies by race, see Suzanne Poirier, Chicago’s War on Syphilis, 1937-1940: The Times, the “Trib,” and the Clap Doctor (Urbana, IL: University of Illinois Press, 1995), 118-147.

345 combination of segregated practices in housing, discrimination, and unemployment left

African Americans with few alternatives to improve their outlook. Unemployment rates in Southern cities and towns were two to three times greater than those of whites.135 By

1935, 30% of all blacks in the country received some type of relief.136

Thus, treating syphilis held some significant problems. Although the historian

Edward H. Beardsley found that “Unlike whites, few blacks associated syphilis and gonorrhea with immorality or any loss of social standing,” blacks received minimal care.137 According to Parran, there were “25 times as many Negroes with positive

Wassermann tests for syphilis” as those receiving care.138 Parran asserted that this was a problem of access to medical professionals. The health departments and public health services in urban areas were often disorganized, while in rural areas doctors and nurses were few and far between.139 Discrimination, economics, and numbers exacerbated this situation. Including doctors, dentists, and nurses, there were approximately 11,000 black

134 Myrdal, An American Dilemma, 376-378; John F. Bauman, Public Housing, race, and Renewal: Urban Planning in Philadelphia, 1920-1974 (Philadelphia, PA: Temple University Press, 1987), 32.

135 Cheryl Lynn Greenberg, To Ask for an Equal Chance: African Americans in the Great Depression (New York, NY: Rowman & Littlefiled Publishers, Inc., 2009), 26.

136 Olen Cole, Jr., The African American Experience in the Civilian Conservation Corps (Gainesville, FL: University of Florida Press, 1999), 11.

137 Beardsley, A History of Neglect, 117.

138 Parran, Shadow on the Land, 172. This issue of blacks receiving little medical care after being diagnosed with a disease was pervasive. A study on TB found that in some communities as many as 25% of black victims die without seing a doctor. See Elaine Ellis “Tuberculosis Among Negroes,” The Crisis, April, 1939: 112 & 125, 125.

139 Parran, Shadow on the Land, 134-140, 163, 176; Myrdal, An American Dilemma, 172. 346 health professionals available to take care of a population of almost 12 million.140

Nationally, studies in the 1930s estimated that 25% of blacks died without receiving medical care.141

In addition to their small numbers, black health experts continued to face discrimination. The Directory of Physicians and Surgeons noted the race of the black physicians and the AMA only permitted doctors to join through local county medical associations, most of which did not accept blacks. By 1934, the AMA included less than

150 black doctors, 50 of which were in New York City. It also required hospitals training interns to hire only members of the local medical society, further limiting advancement for African American physicians.142 In this context, Parran’s 1938 NNHW radio address on the need for more opportunities for training African American physicians was an exemplar of the growing effort towards equal access and a challenge to the establishment.

While Parran envisioned a world in which African American doctors primarily took care of African American patients, it was also a world in which black physicians had training and knowledge equal to that of their white colleagues.143 Parran promoted paternalism,

140 H. A. Callis, “The Need and Training of Negro Physicians,” JNE 4(1) 1935: 32-41; Numa P. G. Adams, “Sources of Supply of Negro Health Personnel: Physicians,” JNE 6 (1937): 468-476; Robert B. Eleazer, “A Brief Survey of the Negro’s Part in American Medical History,” NNHN 2(3) 1934: 13; McBride, Integrating the City of Medicine, 80-81.

141 Beardsley, A History of Neglect, 17.

142 Elmer A. Carter, “Racial Prejudice in the Medical Profession,” Opportunity 12(10) (October 1934): 295; Woodson, The Negro Professional Man and the Community, 118-119; Starr, The Social Transformation of American Medicine, 168; Beardsley, A History of Neglect, 77.

143 Thomas Parran, “Special Radio Address, Year 1938 National Negro Health Week,” NNHN, vol. 6, no. 1, January-March 1938, 2. See also Thomas Parran, “No Defense for Any of Us,” “National Negro Health Week, Twenty-fifth Observance: April 1-30, 1939,” PHS, Washington, D.C., 1939, N/P, T27.2:N31 939, box T 702, Publications of the Federal Government, RG 287, NARA II. 347 white training of black medical professionals, over segregation, a trend in public health at that time.144 Although Parran stopped short of promoting racial equality, the NAACP and the NMA still supported this effort to have a proportional number of physicians and hospitals based on the black population as a step towards black health improvement.

They aligned themselves with Parran’s syphilis program, which contributed to the PHS hiring two black physicians to work on venereal disease.145

Health education was a primary focus of Parran’s campaign in working with African

Americans. According to the historian David McBride, “Parran believed that health consciousness among blacks in recent years had been rising, but not high enough.”146 In addition, McBride explains that Parran thought “black people’s cultural bond was impenetrable without black health workers or civic leaders laying the groundwork.”147

This emphasis on health education, and the need for black leaders, and not just physicians, to provide it were part of the origins of NNHW and made it a good match for

Parran’s program. NNHW also provided him with a mechanism to ensure that the government would control the health message.

144 Several historians have noted this trend. See for example: Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill, NC: The University of North Carolina Press, 2001), 47; Pete Daniel, “Black Power in the 1920s: The Case of Tuskegee Veterans Hospital,” Journal of Southern History 35 (1972): 368-88; Poirier, Chicago’s War on Syphilis, 1937-1940, 138-139.

145 McBride, From TB to AIDS, 113-118; A. W. Dumas, “National Negro Health Observance,” Journal of the National Medical Association (JNMA) 28(2), May 1936: 79-80; R. A. Vonderlehr, “Two Negro Physicians in Division of Venereal Diseases, U. S. Public Health Service,” “National Negro Health Week, Twenty-fifth Observance: April 1-30, 1939,” PHS, Washington, D.C., 1939, N/P, T27.2:N31 939, box T 702, Publications of the Federal Government, RG 287, NARA II; McBride, Integrating the City of Medicine, 84, 136-137.

146 McBride, From TB to AIDS, 112.

147 McBride, From TB to AIDS, 112. See also Parran, Shadow on the Land, 163-165. This position also established Brown as one of the members of Roosevelt’s Black Cabinet. 348

Parran and Brown: NNHW 1937-1941

During Parran’s tenure, Roscoe C. Brown’s power grew. In 1934, Cumming appointed him Health Education Specialist as the director for the Office of Negro Health

Work, making him an administrator and giving him a staff.148 Brown decreased the size of the NNHM Committee to just Bowles and Adams, and made the Committee an advisory position. The NNHW Committee, with Brown as Chairman, became the leading committee for the campaign.149 Brown’s name was on every NNHW document and he was the primary point of contact for radio addresses and editor of the News.

Under his watch, the NNHW Committee expanded from five to 15 people by 1941.

Much of this growth took place after Parran became Surgeon General, extending the influence of NNHW to support Parran’s emphasis on health education. The Committee still included long-time participants F. Rivers Barnwell, T. M. Campbell of the

Cooperative Extension Service, Algernon Jackson, and a representative from the NNIA.

The expansion included a variety of education and health oriented groups, mostly along the east coast. Representatives from the National Dental Association (a black organization constructed in a similar vein to that of the NMA), the Negro Organization

Society of Virginia, the South Carolina Tuberculosis Committee, and the Southern

Education Foundation all participated. The Committee also continued its push to reach

148 “National Negro Health Week, Twenty-fifth Observance: April 1-30, 1939,” PHS, Washington, D.C., 1939, N/P, T27.2:N31 939, box T 702, Publications of the Federal Government, RG 287, NARA II.

149 “National Negro Health Week: Twenty-sixth Observance, March 31-April 7, 1940,” FS 2.2: N3.2: 1940, FS 2.2: N16-Fs 2.2:N88/2/969, FS 66, Records of the Government Printing Office, RG 149, NARA II. 349 out to women as Modjeska Montieth Simkins and Shellie T. Northcutt, representing a health and education group respectively, joined Nurse Staupers.150 Thus, by 1941 the

NNHW Committee comprised a variety of organizations from both medical establishment and lay backgrounds as it sought to better integrate health education into the Week. However, the medical establishment still held final say over the Week’s activities due to Brown’s position as Chairman and the Week’s PHS funding.

With Brown’s greater oversight, the bulletin that had undergone significant change every one to two years stabilized. The text describing the responsibilities of NNHW committees, the daily themes of the Week, and even the list of cooperating organizations remained relatively unchanged between 1930 and 1941.151 The biggest change to the bulletin was the increase in pictures. The cover page photo usually had a picture of that year’s theme, such as a family, a school, or a health agency. Starting with the 1935 issue,

Brown organized the eight-page bulletins so that readers could unfold the four pages of text to reveal a spread of pictures depicting various aspects of NNHWs from across the country.152 While previous issues had provided detailed information about particular

NNHW activities in a given community, Brown’s goal was to illustrate what NNHW looked like.

150 “National Negro Health Week: Twenty-sixth Observance, March 31-April 7, 1940,” FS 2.2: N3.2: 1940, FS 2.2: N16-Fs 2.2:N88/2/969, FS 66, Records of the Government Printing Office, RG 149, NARA II.

151 “National Negro Health Week: Sixteenth Annual Observance {1930}, Sunday, Mary 30, to Sunday, April 6,” PHS, Washington, D.C., 1930, inside cover and 1-2, box 1 folder 3, NNHW, TA; “National Negro Health Week – Twenty-Seventh Observance: March 30 – April 6, 1941,” PHS, Washington, D.C., 1941, 2-3, folder “Health-National Negro Health Week,” Vertical Files, TA.

152 See for example “National Negro Health Week, Twenty-first Annual Observance: Sunday, March 31, to Sunday, April 7, 1935,” PHS, Washington, D.C., 1935, folder 3, box 13, NNHW, TA. 350

Taking the concept of “a picture is worth a thousand words” to heart, Brown chose Figure 5 pictures that clearly depicted various activities that the NNHW Committee wanted local NNHWs to organize. They showed baby contest winners, newspaper clippings of

NNHW activities, yards and homes cleaned up, health exhibits, and health plays and parades at schools. However, the largest category of pictures involved images promoting the medical establishment, specifically doctors and dentists performing checkups and nurses working with the public. 1936 NNHW Bulletin When the 1938 bulletin declared, “The Way

To HAVE HEALTH Is To ACT HEALTH,” it meant see a physician for a physical exam, not whitewash a house.153

153 While the 1939 and 1940 bulletins were not in the same format described above of the 8 page bulletins, they had similar pictures. See “National Negro Health Week, Twenty-first Annual Observance: Sunday, March 31, to Sunday, April 7, 1935,” PHS, Washington, D.C., 1935, folder 3, box 13, NNHW, TA; “National Negro Health Week, Twenty-second Annual Observance: Sunday, March 29, to Sunday, April 5, 1936,” “PHS, Washington, D.C., 1936, folder 1, box 8, NNHW, TA; “National Negro Health Week, Twenty-third Annual Observance: Sunday, April 4, to Sunday, April 11, 1937,” PHS, Washington, D.C., 1937, folder 5, box 13, NNHW, TA; “National Negro Health Week, Twenty-fourth Annual Observance: Sunday, April 3, to Sunday, April 10, 1938,” PHS, Washington, D.C., 1938, T 27.2: N31 938, “National Negro Health Week, Twenty- fifth Observance: April 1-30, 1939,” PHS, Washington, D.C., 1939, T27.2:N31 939, box T 702, Publications of the Federal Government, RG 287, NARA II; “National Negro Health Week, Twenty-sixth Observance: March 31 – April 7, 1940,” PHS, Washington, D.C., 1940, FS 2.2:N31.2 940, box FS 66, Records of the Government Printing Office, RG 149, NARA II; “National Negro Health Week – Twenty-Seventh Observance: March 30 – April 6, 1941,” PHS, Washington, D.C., 1941, PHS, Washington, D.C., 1941, folder “Health-National Negro Health Week,” Vertical Files, TA. Brown notes that all bulletins have the same basic format as described 351

The goal of seeing a physician was more attainable for African Americans than it used to be. While the ratio of black physicians to the black population was 1:3,377, outside the South it was 1:1,652, and in cities with more than 50,000 African Americans it was 1:1,464 in the North and 1:1,862 in the South. Although these figures were far higher than the national white ratio of 1:750, they were far lower than the black South’s

1:4,913 and black Mississippi’s tragic 1:18,527.154 More importantly, by 1940, 48% of blacks lived in urban areas and 23% of all African Americans lived in the North, meaning that blacks had their greatest access ever to medical professionals.155

While the increasing number of blacks in the North encouraged white physicians to start seeing black patients, this was not due to a sudden change in racist beliefs, but instead due to an interest in the economic benefits of seeing more patients. Many residency programs still refused to admit African American doctors and white hospitals in the majority of cities continued to deny them hospital appointments and staff privileges. Following decades of pressure from black civil rights, medical organizations, and physicians, white hospitals in Detroit, Philadelphia, Chicago, New York City, and elsewhere gradually opened their doors to black medical professionals and patients.156

above, see Brown, “National Negro Health Week Movement,” 556. The exceptions were 1939 and 1940, which did not unfold and were longer than 8 pages.

154 Paul B. Cornely, “Distribution of Negro Physicians in the United States in 1942,” Journal of the American Medical Association (JAMA) 124(13) 1944: 826-830.

155 U.S. Bureau of the Census, Statistical Abstract of the United States, 1946 (Washington, D.C.: U.S. Department of Commerce, 1946), 17; U.S. Bureau of the Census, Statistical Abstract of the United States, 1955 (Washington, D.C.: U.S. Department of Commerce, 1955), 33.

156 For more on the changes to racist medical practices in hospitals and the ways medical organizations and physicians fought for African American doctors to gain access to these medical credentials, see Chapter 6. 352

Although the changes in hospital policy helped support the health of blacks in urban areas, the bulletin had nothing in the way of specific practices it could offer to improve the health of those living far from medical professionals. While it showed pictures of sanitary privies, it did not include information on how to create one. The photographs of clean houses came without the formula for whitewash.

Brown and the speakers he chose also continued NNHW’s emphasis on health as a non-racial issue. Parran asserted that, “Every citizen north and south, colored and white, rich and poor, has an inalienable right to his citizen’s share of health protection.”157 In selecting the 1939 theme, “The Citizen’s Responsibility for the Health of the

Community,” Brown echoed Parran in noting that “The term, ‘citizen,’ is all inclusive.”158 Speaking the next year, Dr. Robert Olesen, an Assistant Surgeon General, noted that “The term national Negro Health Week is a pleasing and convenient misnomer…because the work is of obvious value to the white as well as the Negro population.”159

That these kinds of comments on interracial work and the health of the human race, of whites and blacks together, grew during the New Deal era illustrated the influence of the

Roosevelt Administration. It wanted to promote programs and services to attract black voters, but without offending Southerners. Health, an issue that affected both races, provided a perfect topic. The interest in black voters also reflected the organizing power

157 Thomas Parran, “Special Radio Address, Year 1938 National Negro Health Week,” NNHN 6(1) 1938: 2.

158 Roscoe C. Brown, “Radio Broadcast”, NNHN 6(2) 1938: 1-5, 5.

159 Robert Olesen, “The Citizen’s Responsibility for Community Health,” N/D, 1939, 1, folder 8, box 12, NNHW, TA. 353 of the NAACP to challenge laws that were racially discriminatory and rally the black public around social justice.

Locally, NNHWs continued to promote interracial work. Many mayors who endorsed

NNHW in the late 1930s called upon all the city’s citizens, not just the black ones, to participate.160 White non-health oriented organizations also continued to join in NNHW.

YMCAs and YWCAs provided speakers or lecture space. The Boy Scouts of America’s

Negro affiliate conducted home inspections, organized cleanups, distributed health literature, and even had scouts featured on the bulletin’s 1941 cover.161

The goals of local Weeks remained relatively the same as in the past. Most Weeks promoted the use of medical professionals in some way, such as vaccination drives, clinic attendance, or raising money for a hospital or health unit.162 Chicago made specific

160 J. G. Lemon, “News of Interest to Colored People,” Savannah Press, April 2, 1937, “THC, 1937,” 291, TA; “Mayor Bruce Issues Proclamation for Negro Health Week,” Winnfield News-American, April 23, 1937, “THC, 1937,” 297, TA; Frank L. Shaw, “Health Week proclamation,” NNHN 6(2) 1938: 10.

161 “”Annual Health Week Program Gets Underway,” Houston Informer, April 4, 1936, “THC, 1936,” 526, TA; Launch ‘Health Week’ Program at Muncie,” Indianapolis Recorder, April 3, 1937, “THC, 1937,” 295, TA; “Negro Health Week Activity Being Planned,” Chattanooga News, march 26, 1937, “THC, 1937,” 314-315, TA; “What is the National Negro Health Movement,” NNHN, vol. 6, no. 4, October-December, 1938, 7; “Report of Negro Health Week Work,” “Health Fair Scheduled,” Cleveland Plain Dealer, April 3, 1939, “THC, 1939,” 337, TA; “Scouts to Cooperate in Negro Health Work,” Philadelphia Tribune, March 23, 1939, “THC, 1939,” 338, TA; “National Health Week Inaugurated by Negro Organization Society of Virginia in 1913,” Norfolk Journal and Guide, April 1, 1939, “THC, 1939,” 340, TA; “Negro Health Week,” Anniston Star, April 3, 1939, “THC, 1939,” 314, TA; “Negro Activity in Clean-Up Week Gets High Praise,” Atlanta Journal, April 12, 1939, “THC, 1939,” 325, TA; “Negroes to Launch Week-Long Parley on Health Problems,” Philadelphia Inquirer, April 2, 1939, in T”HC, 1939,” 338, TA; “Negroes to Open health Campaign,” Raleigh News & Observer, March 31, 1940, “THC, 1940,” 40, TA; “Raleigh Negroes Hold Adult Health Meeting,” Raleigh News & Observer, March 4, 1940, “THC, 1940,” 41, TA; “Greater Boston Society,” Baltimore Afro-American, April 20, 1940, 22; “National Negro Health Week,” Louisburg Times, March 28, 1941, “THC, 1941,” 1025, TA.

162 “A Health Unit for Hale County,” Moundville News, April 8, 1937, “THC, 1937,” 276, TA; “Negro Leaders Fight Disease,” Birmingham Post, May 14, 1937, “THC, 1937,” 279, TA; J. G. Lemon, “News of Interest to Colored People,” Savannah Press, April 2, 1937, “THC, 1937,” 291, TA; “Negro Health Week,” Sussex Recorder, April 9, 1937, “THC, 1937,” 302, TA; “Negro health 354 numbers of babies medical professionals saw or x-rays taken a feature of its Weeks, and

Baltimore provided financial aid to parents who took their kids to clinics for NNHW baby contests.163 While some communities jumped on Parran’s syphilis coattails and made the disease the focus of NNHW, it mostly received the same amount of attention as it had in the past.

Clinic attendance promoted the status of physicians and allowed patients to engage with local doctors, but many communities continued to worry about the relationships between doctors and the local community. In historian Carter Woodson’s study of

African Americans in the early 1930s, he found that many blacks believed that black doctors were not as good as white ones.164 Patient inexperience with physicians, particularly in the rural South, was also a concern. Parran and other health experts worried that physicians would be unable to convince sick blacks to continue appropriate treatments over long periods of time.165 Doctors exacerbated these problems by confusing patients and not explaining their methods and procedures. During the Tuskegee Syphilis

is Subject of Article,” Cape Charles Times, April 1, 1937, “THC, 1937,” 317; “National Negro Health Week,” Manassas Journal, April 4, 1937, “THC, 1937,” 319, TA; “Anne Law: Health Week Coming! Good Health A ‘Must’ In Modern Times,” Philadelphia Tribune, March 31, 1938, 5; “Woman Medici Leads Jersey Health War,” Baltimore Afro-American, April 2, 1938, 6; H. S. Murphy, “Brass Tacks,” Atlanta Daily World, March 29, 1939, “THC, 1939,” 320, TA; “Hinds Negro Health Work is Outlined,” Jackson News, March 31, 1939, “THC, 1939,” 331, TA; “Negro Health Week Program,” Bristol News-Bulletin, April 7, 1939, “THC, 1939,” 352, TA; “National Negro Health Week is Being Observed,” Oxford Ledger, April 1, 1941, “THC, 1941,” 1026, TA; “Negro Health Week Plans Completed,” Bristol Herald-Courier, March 23, 1941, “THC, 1941,” 1031, TA.

163 “Mammoth health Week program is Launched,” Chicago Defender, March 28, 1936, 6; “Health Week Observed at X – Ray Center,” Chicago Bee, April 6, 1941, “THC, 1941,” 1022, TA; “Baby Contest: Negro Health Week,” Baltimore Afro-American, March 26, 1938, 20.

164 Woodson, The Negro Professional Man and the Community, 96-07, 316-317. See also Myrdal, An American Dilemma, 172.

165 Parran, Shadow on the Land, 161-163; Poirier, Chicago’s War on Syphilis, 1937-1940, 143. 355

Experiment, physicians never explained to their patients the many tests they ran, and often used the phrase “bad blood” to describe syphilis. Problematically, the term “bad blood” had multiple meanings to African Americans, making comprehension difficult.166

Such misunderstandings led some communities to orient their NNHWs around building better communication between doctors and the community. To paraphrase one physician: “scientific medical men were poor speakers, whereas those less fortunately endowed were frequently able to emotionally sway their listeners.”167 This explanation also helps in understanding why demand for folk healers and other health practitioners outside of the medical establishment remained high. To build clarity in medical messages and trust in the profession, Kansas City Missouri’s Week included a course for doctors on public speaking.168 In Philadelphia, the University of Pennsylvania’s Christian

Association sponsored a doctor to show films on immunization for diphtheria and small pox. After the film, the doctor led a talk on exactly how these immunizations worked.169

With both initiatives, the idea was to have physicians articulate their medical concerns and procedures in ways easily understandable to laypersons, thereby improving the health education and understanding of the populace and, ideally, its trust in physicians.

166 Jones, Bad Blood, 72-73, 129; Reverby, Examining Tuskegee, 22. On the general inscrutability of a visit to the doctor, see also Ralph Matthews, “Watching the Big Parade: Is Health Necessary?” Baltimore Afro-American, April 2, 1938, 4.

167 E. B. Perry, “Progress of the National Negro Health Week in Kansas City, Missouri,” NNHN, vol. 6, no. 1, January-March, 1938: 21-24, 23.

168 E. B. Perry, “Progress of the National Negro Health Week in Kansas City, Missouri,” NNHN 6(1) 1938: 21-24, 23.

169 “Dr. Ferebee on health Week Program,” Philadelphia Tribune, April 11, 1940, 7. 356

As for the NMA, the biggest contribution it made directly to the Week was to convince more physicians to participate.170 In a 1929-30 survey, Woodson found that only 1.2% of black physicians participated in NNHW.171 However, after PHS takeover of the Week, a survey of black doctors for 1934-1935 found that 69.7% of respondents reported participating in NNHW, by far the highest percentage of black doctor involvement in any public health activity.172

Indirectly, the NMA supported NNHW goals by partnering with the NAACP to lobby the government for greater support for black use of medical facilities. Bowles, Kenney, and Dr. Louis T. Wright led these discussions for black racial parity in access to these facilities, especially those the government funded in the South. They were also heavily involved in the negotiations that led to the Hill-Burton Act in 1946. This Act guaranteed parity in funding and facilities for health care projects where segregation was the law.173

Although blacks still did not receive equal treatment, the work of the NAACP and NMA led a large number of facilities and services to open their doors to African Americans, hire a few black nurses, and grant limited hospital privileges to black doctors.

Yet support for the Week was not unanimous among black physicians. Objections generally concerned the “Negro” element. Dr. Wright asked “Why should we be singled

170 “National Negro Health Week,” JNMA, 27(1) 1935: 32; “Negro Health Week,” JNMA 30(1) 1938: 30; “National Negro Health Week,” JNMA 33(2) 1941: 88-89.

171 Woodson, The Negro Professional Man and the Community, 115.

172 Paul B. Cornely, “Post Graduate Medical Education and the Negro Physician,” JNMA, 30(1) 1938: 18-22, 20. While the NMA conducted the survey, it sent the survey to all Negro physicians. The data discussed is for the 525 responses he received. Even if all the rest of the approximately 4,000 black physicians did not participate in NNHW, the total number participating would be 9% of all black doctors, a significant increase over Woodson’s findings.

173 Thomas, “The Hill-Burton Act and Civil Rights,” 837-840. 357 out for a health week celebration any more than any other group?”174 He referred to the

Week as “dishonest” due to its focus on racial health, and not health generally, and others noted that people of other ethnicities did not have their own Weeks.175 While the Week shared many similarities to public health campaigns aimed at European immigrants, there was no “Italian Health Week,” or “Jewish Health Week.” From Wright’s perspective, it was deceitful to portray the health of one race as significantly different than the health of any other race since no race was inherently unhealthy. Wright could support this medical facility parity instead of integration as a pragmatic approach to get health care to more blacks on a large scale. He could not abide a public health campaign that separated the races by falsely asserting that blacks had different health needs than whites.

Wright’s attack on the Week was just one of a growing 1930s trend of African

Americans voicing their concerns about racial separation in health. Wright’s Manhattan

Medical Society opposed segregated black hospitals. This position led it into conflict with the Julius Rosenwald Fund in New York City, and even the NMA over the building of a black U.S. Veterans’ Administration Hospital.176 The impact of the vast changes occurring in the nation and world influenced the Society’s position, including the numerous legal victories the NAACP scored, the nascent civil rights movement and

174 “Dr. Wright Socks Health Week in the Eye,” Baltimore Afro-American, March 26, 1938, 13.

175 “Dr. Wright Socks Health Week in the Eye,” Baltimore Afro-American, March 26, 1938, 13; “Dr. Wright Socks health Week’s Other Eye: Prevent Syphilis, He Says, Don’t Just Treat It,” Baltimore Afro-American, May 7, 1938, 1-2; Rothall Gardner, “Why Negro Health Week?” Baltimore Afro-American, April 23, 1938, 4.

176 The Manhattan Medical Society, “Identical Care and Treatment by the Federal Government: An Open Letter To the American Legion,” New York City, NY, Pamphlet No. 2, August 15, 1932: 1-7, Manhattan Medical Society, 120353, New York Academy of Medicine, NY, NY; P. Preston Reynolds, “Dr. Louis T. Wright and the NAACP: Pioneers in Hospital Racial Integration,” AJPH 90(6) 2000: 883-892, 887-888. 358 demand for equality in all areas of American society. It was also part of northern black physicians and the NMA pressing white medical institutions for residency appointments, admittance to practice, and admission of black patients.177

Although the NAACP often supported the NMA’s pragmatic approach, it depicted segregated hospitals as perpetuating segregation and creating a sense of inferiority in blacks and superiority in whites.178 Additionally, the historian Harry F. Dowling has noted that black hospitals often became political tools, with greater funding coming with the expectation of greater black turnout in elections.179 However, while a growing number of physicians disagreed with this singling out of the races in NNHW and forced separation in hospitals, most saw the positive effects of health promotion to a population that often lived in the poorest environments most susceptible to disease. They argued that the positives outweighed the negatives and came out in support of the Week.180

Assessing NNHW 1937-1941

177 For more on the 1930s shift, see Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York, NY: Oxford University Press, 1995), 142-150. For coverage of this shift in the 1940s, see Thomas, “The Hill-Burton Act and Civil Rights,” 840-842.

178 Alfred Perkins, Edwin Rodgers Embree: The Julius Rosenwald Fund, Foundation, Philanthropy, and American Race Relations (Bloomington, IN: Indiana University Press, 2011), 146-149; Kenneth Kusmer, A Ghetto Takes Shape; Black Cleveland, 1870-1930 (Urbana, IL: University of Illinois Press, 1976), 268.

179 Harry F. Dowling, City Hospitals: The Undercare of the Underprivileged (Cambridge, MA: Harvard University Press, 1982), 159.

180 William N. Jones, “Day By Day,” Baltimore Afro-American, April 2, 1938, 4; Daniel B. Taylor, “Asks Dr. Wright to Join War on Syphilis or Poor Pay,” Baltimore Afro-American, May 28, 1938, 4. 359

Parran’s commitment to attacking syphilis, Brown’s efforts to expand the campaign, and the increasing worries about national security that began in the late 1930s all contributed to an enormous increase in NNHW participation. Whereas under Cumming, attendance at NNHW events had increased by 50% between 1933 and 1936, under

Parran’s early tenure that figure jumped 368% from 1936 to 1941 , climaxing in 4.2 million participants at the start of the new decade.181 Some of this growth is hard to explain. Did people come because they saw more pieces of literature (213% increase), more newspaper articles (295% increase), or heard more radio talks (180% increase), than during Cumming’s administration? Did the increased attendance at movies (155%) health exhibits (350%), and health plays and pageants (199%) drive more reporting and discussion of the Week?

Regardless, the data reveals that under Parran, NNHW continued its previous work in most ways. The campaign encouraged overtures to the print media and utilized the newest media of radio and film as much as possible, both as an education and publicity tool. In terms of activities, the campaign continued to do cleanups and attack insects and rodents. Between 1933 and 1941, the percentage of homes and lots cleaned increased by

364%, similar to the overall increase in the number of communities participating (314%).

The average NNHW community campaign cleaned up almost 23 homes and lots in 1933

181 This percentage increase does not include sermon attendance, a statistic that was not collected between 1933 and 1936. Including these figures makes the attendance increase between 1936 and 1941 480%. The total attendance noted does include the sermon attendance. See “Statistical Report: National Negro Health Week - 1936,” NNHN 4(3) 1936: 2-3; “Statistical Report: National Negro Health Week - 1937,” NNHN 5(3) 1937: 2-3; “Statistical Report: National Negro Health Week - 1938,” NNHN 6(3) 1938: 2-3; “Statistical Report: National Negro Health Week - 1939,” NNHN 7(3) 1939: 2-3; “Statistical Report: National Negro Health Week - 1940,” NNHN 8(3) 1940: 4-5; “Statistical Report: National Negro Health Week - 1941,” NNHN 9(3) 1941: 2-3. 360 and more than 25 in 1941. These statistics indicated that the NNHW campaign promoted cleanups in an understanding of the environmental conditions African Americans faced.

Indeed, some local campaigns still made clean homes and lots their primary focus.182

However, while the number of projects focused on fighting rodents (276%), building outhouses (112%), and painting (220%) all increased during this period, they did not grow at the same rate as community participation. The average community had 12 anti- rodent projects in 1933, but only 11 in 1941. Similarly the number of outhouse projects fell from 2.3 to 1.2 per community and the number of painting projects from 1.6 to 1.2 in each local Week. Some of the reasons for these changes are easy to understand. The extension of sewer services into more black communities decreased the need for outhouse projects. Additionally, the campaign no longer targeted those in the largely rural South where whitewashing and outhouse upkeep were more of a necessity than in the crowded urban North.

The most illustrative statistics in terms of this change in NNHW emphasis were those on planting and flower projects, and those that encouraged cleaning areas other than homes and lots. As under Cumming, the campaigns of the late 1930s and early 1940s had little interest in planting and flower projects and general cleanup activities outside of homes and lots. Compared with the 368% increase in attendance, the small 25.5% increase in plant and flower projects, and the decrease of cleanup projects outside of

182 “For Better Health and Happiness Have Cleanliness: Clean Up! Paint Up! Every Home Spotless,” Baltimore Afro-American, April 10, 1937, 18; “National Negro Health Week,” Savannah Tribune, April 7, 1938, “THC, 1938,” 308, TA; “Marion County Observes National Health Week,” Atlanta Daily World, March 31, 1938, “THC, 1938,” 310, TA; “National Negro Health Week Accomplishments: Jackson and Hinds County, Mississippi,” NNHN 8(3) 1940: 28; “Cleanup Drive Planned,” Charleston News & Courier, March 28, 1939, “THC, 1939,” 349, TA; “Launch Negro Health Week,” Bristol News-Bulletin, April 3, 1939, “THC, 1939,” 352, TA; “Health Week, April 2 to 9,” Baltimore Afro-American, March 18, 1939, 20. 361 homes and lots (-17%), the only statistical decline in all the NNHW data between 1936 and 1941, stand out.183 Expanding the data set to 1933, of all the NNHW campaign statistics kept, these were the only two items to actually demonstrate a decrease in numbers, dropping 22% and 41% respectively.184 Looked at through the lens of the average NNHW campaign though, the difference is much more stark. The first year the

PHS ran the Week, the average participating community had 19.5 planting projects and

15.5 cleaning projects. They were the most important elements of the cleanup portion of the average campaign other than cleaning up one’s own personal property. Between 1933 and 1941, these numbers fell precipitously, with the average 1941 NNHW community conducting just 3.7 planting projects and 2.2 other cleaning activities. While the acceptance of basic hygiene and sanitation as legitimate practices to address issues of health and disease during this period explains some of this decrease, these numbers also illustrate the Week’s change in focus.

It is worth noting that the NNHW campaign materials did not change much during this period. The themes of each day of the Week remained the same, including

“Community Sanitation Day” and “General Clean-up Day.” Although the figures undulated from year-to-year, the overall downward trend in the number of cleanup activities of the average Week illustrates the change in the national NNHW Committee’s focus. Whereas specific practices to promote good health were the key elements of

183 “Statistical Report: National Negro Health Week - 1936,” NNHN 4(3) 1936: 2-3; “Statistical Report: National Negro Health Week - 1937,” NNHN 5(3) 1937: 2-3; “Statistical Report: National Negro Health Week - 1938,” NNHN 6(3) 1938: 2-3; “Statistical Report: National Negro Health Week - 1937,” NNHN 7(3) 1939: 2-3; “Statistical Report: National Negro Health Week - 1940,” NNHN 8(3) 1940: 4-5; “Statistical Report: National Negro Health Week - 1941,” NNHN 9(3) 1941: 2-3.

184 “Statistical Report: National Negro Health Week - 1933,” NNHN 1(2) 1933: 2-3. 362

NNHW under Tuskegee’s leadership, with Brown and the PHS the focus was more about interesting people in the topic overall. Health talks, parades, and movies promoted health as a topic for investigation, but tied the ways to discover and gain “proper” health to seeing physicians, getting vaccinations, and supporting the medical establishment.

Lectures remained a driving force in getting people to come out for the Week. The number of lectures grew 257% between 1936 and 1941, which paralleled the overall increase in the number of participating communities. However, while the average number of lectures remained at about two per community, the average attendance at these events changed substantially. Between 1933 and 1936, the average NNHW lecture drew just over 100 people, but between 1936 and 1941, lecture attendance surged by 496% to an average of 183 attendees.185 Identifying the reason for this attendance change is difficult.

Lectures were the easiest things for communities to organize since they did not require negotiating with a radio station or movie house for time or programming. Lectures were also straightforward to organize with cooperating agencies, such as the NTA, which had a lot of experience with this type of activity and only needed to provide the speaker, which required little advance organization or cost.186

Another possible reason for greater lecture attendance is that under Parran, NNHWM developed closer ties to other government programs, particularly the WPA, NYA, and

CCC. Such connections made sense given that the WPA and NYA both had mandates to

185 While the average attendance per lecture was 183, this did not mean that most lectures had this number of attendees. Rural areas and small towns had far less participation, and cities had numbers that exceeded this average.

186 “Statistical Report: National Negro Health Week - 1936,” NNHN 4(3) 1936: 2-3; “Statistical Report: National Negro Health Week - 1936,” NNHN 4(3) 1936: 2-3; “Statistical Report: National Negro Health Week - 1941,” NNHN 9(3) 1941: 2-3. 363 promote education. In this capacity, NNHW organizers teamed up with the WPA’s and

NYA’s local and state efforts to promote African American health education. The infrastructure of these two government agencies at the state and local level offered

NNHW organizers the opportunity to reach more people. The WPA was particularly useful here since it conducted a project in almost every community in the country. These agencies could also appeal to state and local health departments, providing another voice to the PHS’ calls to participate. Additionally, the WPA could work year-round on the

NNHM campaign. The WPA had the funds to support surveys and statistical analyses of health issues in addition to organizing the building of hospitals and sanitariums.187

The CCC’s involvement in the Week also grew under Parran. The 1938 Week featured programming at more than 100 African American camps across the country, and all camps for blacks participated in 1939 and 1940. The CCC’s NNHW involved a national campaign across its African American camps that CCC directors Robert

Flechner and then James J. McEntee announced themselves. The CCC often made attendance at the health exhibits and lectures for NNHW mandatory, artificially increasing lecture attendance. In addition, the CCC’s program was somewhat unique for

NNHW in that it taught first aid courses and reinforced basic personal hygiene and

187 “WPA Aids Observance of Negro Health Week,” Philadelphia Tribune, April 8, 1937, 2; “Various Activities Feature Government Aid in Health Observance Week,” Pittsburgh Courier, April 18, 1937, “THC, 1937,” 309, TA; “Race Health Week Observed Apr. 4-11,” Chicago Defender, April 10, 1937, 21; “WPA Group Pledges Health Week Support,” Chicago Defender, March 12, 1938, 3; “Fulton, DeKalb N.Y.A. In Extension of Health Week,” Atlanta Daily World, April 13, 1937, “THC, 1937,” 292, TA; “Illinois Women Observe Health Week Program,” Chicago Defender, April 16, 1938, 17; “Give Program for Negro Health Week,” Houma Courier, March 27, 1939, “THC, 1939,” 328, TA; “NYA Plans for Health Week in New Jersey,” Baltimore Afro- American, March 30, 1940, 2; “Decatur and Macon County, Illinois, Made Gain in Organized Sponsorship of Negro Health Week,” NNHN 8(3) 1940: 29; Mae M. Palfrey, “Louisiana NYA and National Negro Health Week,” NNHN 8(4) 1940: 30; T. W. Josey, “National Negro Health Week in Augusta, Georgia,” NNHN 9(3) 1941: 17-18. 364 diet.188 Here, the CCC’s efforts reflected both its goals of creating independent, “manly,” workers who could care for themselves and emphasizing the citizen-soldier, the latter a change that occurred in the late 1930s as the threat of war loomed.189

Consistent with the efforts of the CCC, one other possible explanation both for the increase in lectures and overall attendance was the international crisis that came about in the late 1930s and into the 1940s. As Germany and Japan aggressively attacked their neighbors, the U.S. began to rearm itself and the government began national defense planning. As discussed earlier, the draft during World War I had created worries about the nation’s health due to the number of rejections, and so health became a larger concern again as the U.S. started to mobilize its citizens and industries. As President Roosevelt stressed in the fall of 1940, “Today the need for conservation of health and physical fitness is greater than at any time in the nation’s history….We cannot be a strong nation unless we are a healthy nation.”190

In addition to the work of the Week at CCC camps and in Baltimore with the city’s

NNHW marathon, the Roosevelt Administration included African Americans in these

188 “100 CCC Camps Observe Negro Health Week,” Chicago Defender, April 2, 1938, 5; “CCC Camps to Observe Negro Health Week,” Philadelphia Tribune, March 31, 1938, 10; “CCC Camps to Mark Birthday, Health Week,” Baltimore Afro-American, April 8, 1939, 12; “CCC Looks Back Upon Six Years of Continuous Progress,” Chicago Defender, April 8, 1939, 6; “Civilian Conservation Corps and National Negro Health Week,” NNHN 7(3) 1939: 22; “CCC Director Says Unit to Observe Health Week,” Chicago Defender, April 6, 1940, 8; “C.C. Camps to Observe Negro Health Week,” Philadelphia Tribune, March 21, 1940, 20; “CCC to Observe Negro Health Week,” Atlanta Daily World, March 21, 1940, “THC, 1940,” 34, TA; Smith, Sick and Tired of Being Sick and Tired, 69-70. The first CCC director was Robert Fechner, who died in 1939 and was succeeded by James J. McEntee.

189 For more on this transition in the CCC, see Jeffrey Ryan Suzik, “‘Building Better Men’: The CCC Boy and the Changing Social Idea of Manliness,” Men and Masculinities 2(2) October 1999: 152-179.

190 Franklin D. Roosevelt, address at the dedication of the National Institute of Health, October 31, 1940, reprinted in NNHN 8(4) 1940: 8. 365 health plans. The Council of National Defense created a subcommittee on Negro Health full of NNHW leaders. M. O. Bousfield and Mabel K. Staupers were two of the five appointees and Roscoe Brown acted as a consultant. The committee discussed ways to mobilize African Americans and assure proper health and medical treatment. However, it also pushed for financial assistance for more medical training and opportunities for

African American health workers, a goal echoed at NNHW events.191

In 1941, the NNHW campaign built upon the concerns of national preparedness. The theme “Personal Hygiene and First Aid Preparedness” was clear and concrete, unlike those previous that had focused on various aspects of community health. While much of the 1941 bulletin remained unchanged from years past, the cover art was noticeably different. Whereas previous covers had portrayed regular citizens acting out the Week’s theme, the cover for 1941 featured Girl Scouts and Boy Scouts in uniform. The military theme, which included a Girl Scout saluting, was accompanied by the text “‘Semper

Paratus’ – Always Prepared” along with the beginning of the pledge of allegiance.192

Here, Brown and the PHS tied black health to patriotism. As Dr. James A. Dolce of the

PHS noted in his radio address that year, “The choice [of the theme] expressed the determination of the Negro people to enter wholeheartedly into the defense plans of our country.”193 More practically, as F. Rivers Barnwell put it in his sermon, “In times of

191 A. W. Dent, “Minutes of Meeting of the Subcommittee on Negro Health, Health and Medical Committee, Council of National Defense,” November 16, 1940, 1-6, Folder 840, Box 91, General Classified Files Office of Administration Federal Security Agency, RG 235, NARA II. See for example, “Negro Health Program, New Jersey, Reports Health Week Results,” NNHN 9(4) 1941: 7-8. 192 “National Negro Health Week – Twenty-Seventh Observance: March 30 – April 6, 1941,” PHS, Washington, D.C., 1941, cover, Folder “Health-National Negro Health Week,” Vertical Files, TA.

366

National Defense, the military forces need larger numbers of strong, healthy men” to work and fight.194

Government officials and local NNHW leaders emphasized the connection between improved black health and a stronger national defense, along with the need for health departments to continue to cooperate in supporting Figure 6 black health improvement.195 A campaign that connected black health with the safety of the entire nation, during a time of military escalation, was bound to receive greater attention. The news that early selective service exams found more than one-third of men unfit for military service only served to reinforce the importance of NNHW’s work.196

In this environment of war preparedness, cleanup 1941 NNHW Bulletin Cover activities were a much tougher sell. Organizers could

193 James A. Dolce, “Personal Hygiene and First Aid Preparedness,” March 29, 1941, 1, FS 2.2:4, N31, FS 2.2:N16-FS 2.2:N88/2/969, box FS 66, Records of the Government Printing Office, RG 149, NARA II.

194 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week,” March 30 to April 6, 1941, 2, FS 2.2:3, N31, FS 2.2:N16-FS 2.2:N88/2/969, box FS 66, Records of the Government Printing Office, RG 149, NARA II. See also James A. Dolce, “Personal Hygiene and First Aid Preparedness,” March 29, 1941, 2, FS 2.2:4, N31, FS 2.2:N16-FS 2.2:N88/2/969, box FS 66, Records of the Government Printing Office, RG 149, NARA II.

195 Charles V. Akin, “Cooperating for Better Health,” NNHN 8(1) 1940: 3-5; James A. Drain, “National Negro Health Week,” April 4, 1941, 8, folder “Health work for Negroes, 02916, box 35, Central File, 1941-44, Records of the Children’s Bureau, RG 102, NARA II; Warren F. Draper, “Health of the Negro in National Defense,” NNHN 9(2) 1941: 7-11, 10; Ballard Norwood, “National Negro Health Week is Being Observed,” Oxford Ledger, April 1, 1941, “THC, 1941,” 1026, TA; “Negro Health Week March 31-April 6,” Sandersville Progress, March 27, 1941, “THC, 1941,” 1021, TA.

196 Clarence Toliver, “The Point Is This,” Baltimore Afro-American, April 5, 1941, 9. 367 link cleaning a home or vacant lot to improving the environment people lived in, which would in turn improve health. However, painting projects and other cleanup activities aimed at beautification seemed more frivolous in the context of impending war. Thus, local NNHW leaders, with tacit NNHW Committee approval, catered to their audience.

They promoted the activities that were most likely to draw attention and publicity: films, lectures, and radio addresses that emphasized the connection between the solider and good health. While getting exercise was an important part, the most important element for good health was to get a physical exam from a physician. Health displays and specific health practices to improve health on one’s own became more of an afterthought as national defense concerns increased.

In conclusion, by the end of the 1930s, the growth and change in NNHW was profound. The resources and publicity the PHS gave to the Week, its partnership with other government agencies, and the interracial movement contributed to a massive increase in attendance, with millions participating each year. The publication of the News made studies and developments related to African Americans in the health field easily accessible and helped local leaders identify both important issues to address and ways of addressing them. Under Brown and the PHS, those ways involved seeing a physician to get a physical exam or vaccination. By the 1940s most understood and accepted that all

Americans should practice good health by bathing and washing their hands, brushing their teeth, and making sure their homes and communities were clean.

Although some African Americans remained concerned about a campaign that implied racial differences in health, the critical voices remained a small minority as black health improved and concerns about the coming war dominated discussion. Perhaps Dr. 368

Robert Olesen, a white Assistant Surgeon General, best summed up the feeling towards the Week in the late 1930s, “I may conclude my remarks by expressing the conviction that the activities of the National Negro Health Week are more penetrating and personal than any public health services now being offered on a nation-wide basis. I am convinced that this movement has been effective in the past, that it is steadily gathering momentum and will in the future make its beneficial influence felt increasingly. If I may be permitted to sound a pleasantly discordant note, it is the hope that the benefits of National Negro

Health Week may be made available to the white population as well.”197

As Olesen noted, the first ten years the PHS ran the Week appeared to augur a bright future for the campaign and its work. Yet the following ten would see the demise of the

Week. How that came about is the subject of the next chapter.

197 Robert Olesen, “The Citizen’s Responsibility for Community Health,” N/D, 1939, 6, folder 8, box 12, NNHW, TA. 369

CHAPTER 6

THE DEATH OF THE MOVEMENT: TIMELY OR UNTIMELY? 1942-1950

Eighteen years ago there was a pressing need to focus attention on the particular health problems of the Negro and to concentrate efforts in a national Negro health movement. Today, we know that this movement has been successful…so successful that there is not the same urgency to emphasize separate needs. Rather the trend now is for all groups to work together for mutual welfare.

-“Special Notice,” News 18(2) April-June, 1950, 1.1

Roscoe Brown’s announcement of the end of the News proposed that the situation facing African Americans that had led the USPHS to take over the Week in 1932 had changed. Not only had African American health improved, but, according to Brown, health care in America had transformed. Brown forecast a future of desegregated health care. It was a grand vision spurred by the health patriotism and broad black participation in World War II. Yet as the NAACP and NMA turned their sights from racial parity in regions that practiced segregation to desegregation, the Week came under increasing attack. Although Brown portrayed the Week as having served its purpose, the bottom line was that a campaign meant to help unite the race, and even the country during the war, now divided it.

World War II and Health Patriotism

The interracial movement of the 1930s helped lay the groundwork for what historian

David McBride calls “health patriotism” during World War II. With “health defense” a

1 “Special Notice” National Negro Health News (NNHN) 18(2) 1950: 1. 370 national priority, national leaders worked to standardize the criteria for national health and nutrition. The goals were the same for whites and blacks as unity required that all groups improve their health.2 The NMA and National Association of Colored Graduate

Nurses (NACGN) convinced the military to admit African American nurses and doctors into the army during the war, and the American Red Cross ended its policy of blood segregation in 1943.3 In explaining the Red Cross’ decision, the historian Keith Wailoo argues that its policy had “no basis in accepted science…[and]…seemed to undermine national solidarity and the goal of equal participation in the war effort.”4 During World

War II, the so-called “accepted science,” used to justify discrimination and segregation was no longer applicable.

Furthermore, in 1944, the sociologist Gunnar Myrdal published An American

Dilemma: The Negro Problem and Modern Democracy. In addition to supporting the idea that germs did not recognize color, Myrdal noted the steep decline in the African

American death rate since the turn of the century, which indicated that the health issues the race faced were due to environmental, rather than biological factors.5 After a lengthy

2 David McBride, From TB to AIDS: Epidemics among Urban Blacks since 1900 (Albany, NY: State University of New York Press, 1991), 125.

3 David McBride, Caring for Equality: A History of African American Health and Healthcare (Lanham, MD: Rowman & Littlefield, 2018), 71-2; Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York, NY: Oxford University Press, 1995), 186; Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill, NC: The University of North Carolina Press, 2001), 89-90; Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore, MD: The Johns Hopkins University Press, 1997), 150.

4 Wailoo, Dying in the City of the Blues, 89.

5 Gunnar Myrdal, An American Dilemma: The Negro Problem and Modern Democracy (New York, NY: Harper & Brothers Publishers, 1944), 140-142, 171. Others came to the same 371 examination of all the studies on African American health, he concluded that “no innate susceptibilities or immunities to specific diseases on the part of the Negro have yet been conclusively demonstrated,” and that “It is no exaggeration to say that no physical difference between the average American Negro and the average American white, not even difference in color, has yet been measured quantitatively by research methods which conform to the rigid standards of statistics.”6 Almost 50 years after Frederick Hoffman had labeled African Americans an endangered species, Myrdal argued that there was little difference between the races and that their health outcomes could be similar if given like circumstances.

The National Themes of NNHWM During the War, 1942-1945

NNHWM reflected the war’s “health patriotism.” The public health campaign emphasized two elements during the war: the link between health and national security; and the idea that blacks and whites were not as different medically as many thought.

Regarding the former, the 1942 and 1943 themes, “Opportunities in the National Defense

Program for Improvement of Community Health” and “Health on the Home Front;

Victory on the War Front,” made the association clear. Brown explained that the purpose of the Week’s radio broadcast was “to relate the community’s health problems, health activities, civilian defense, and war efforts to the challenging theme of home security, successful attainment of the war objectives, and the Four Freedoms for the post-war

conclusion, see for example Frederick D. Mott and Milton I. Roemer, eds. Rural Health and Medical Care (New York, NY: McGraw-Hill Book Company, Inc., 1948), 77.

6 Myrdal, An American Dilemma, 143, 138-139. 372 peace,” and to “stimulate patriotism.”7 Assistant Surgeon General Dr. E. R. Coffey opened his 1942 radio address by stating: “Today all our efforts toward better health are patriotic efforts. Every American, in this time of war, must accept as a part of patriotism the responsibility for doing all he can for his own health and community health.”8

The sermon that F. Rivers Barnwell prepared for the 1943 campaign struck a similar tone, “The soldier on the battlefield and in the training camp will stand or fall in proportion to his health.”9 Even towards the war’s end, Brown continued to hammer home the connection, noting in the 1945 radio address, “Better health means fewer demands on overworked doctors and nurses. It means fewer days of work lost in war plants.”10 That health was important to winning a war was obvious. That proper hygiene was not only smart, but also patriotic, was a new concept and one that made participation in NNHWM during the war years an act of national support.

The connection between health and national loyalty encouraged even more groups to participate in NNHWM. One organization was the U.S. Military. At Ft. Jackson, in South

Carolina, in Lincoln, Nebraska, and in Europe, African American soldiers participated in

NNHWM. Here the program looked a little different than in most U.S. communities since soldiers were not poverty stricken and had access to medical professionals. Instead,

7 Roscoe C. Brown, “Subject: 1943 National Negro Health Week Radio Broadcasts,” March 15, 1943, folder 7, box 14, National Negro Health Week (NNHW), Tuskegee University Archives, Tuskegee AL (TA).

8 E. R. Coffey, “Use Your Chances For Health,” April 2, 1942, 1, folder 5, box 14, NNHW, TA.

9 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 4 to April 11, 1943,”3, folder 7, box 14, NNHW, TA.

10 “1945 National Negro Health Week Recorded Radio Broadcast,” NNHN 13(1) 1945: 2. 373

NNHWM at military bases focused on venereal disease testing and education, along with programs supporting first aid, nutrition, and exercise to reinforce the importance of strong and healthy soldiers.11 Representatives of the army and navy also attended NNHWM programs as recruiters and provided demonstrations of proper health.12

While the American Red Cross had supported NNHW efforts in the past, its participation rose during the war years with its Home Nursing Program. The Program involved inactive nurses training local women in basic health practices so that these women could become more efficient in handling the health concerns of their family and community. The Red Cross sought out black nurses to teach its course to other African

American women, increasing opportunities for health education in the African American community. Many asserted that such efforts were vital to African American health, even if the Program practiced segregation. Gunnar Myrdal argued that “Perhaps the greatest need of the Negroes, in the way of reducing sickness and death, is for a dissemination of knowledge on how to take care of the body in both its normal and its pathological state.”13 Physicians agreed with Myrdal. Doctors Frederick Mott and Milton Roemer explained that “It should be emphasized, too, that many of the special health problems afflicting the rural Negro can be attacked through intensive educational efforts.”14 The

11 “Health Week for Negroes Observed at Fort Jackson,” April 2, 1943, in “Tuskegee Health Collection (THC), 1943,” 418, TA; “National Negro health week at Fort Jackson, S. C.,” NNHN 11(3) 1943: 15; “Service Men Laud Lincoln Health Effort, National Negro Health Week, Lincoln, Nebraska,” NNHN 11(3) 1943: 15; John F. Harris, “National Negro Health Week, ‘Somewhere in France, 1945,’” NNHN 13(3) 1945: 8-9.

12 See for example “Delaware State Observes Negro Health Week,” Chicago Defender, April 15, 1944, 10.

13 Myrdal, An American Dilemma, 174.

14 Mott and Roemer, eds. Rural Health and Medical Care, 546. 374

Red Cross’ Program had the potential to aid many sick blacks and promoted NNHW’s original goals of providing lay people access to basic health education.15

Health education for African American women was particularly important since, prior to the outbreak of World War II, many lacked access to medical care when giving birth.

Looking at rural areas in 1942, Mott and Roemer found that in Georgia, one black baby was delivered in a hospital for every five white babies, whereas 15 black babies were delivered at home for every white one. Further north, they found that even in Maryland,

39.5% of rural African American live births occurred without a medical professional present, as opposed to just 3.4% of white live births.16 Overall, according to Dr. Martha

Eliot, Associate Chief of the Children’s Bureau, in 1941 America, “Untrained midwives attended nearly three-fourths of all Negro births.”17

Mott and Roemer asserted that “the inequitable share of available health services received by Negroes is an expression of their greater poverty rather than their smaller….desire for these services.”18 As Parran and others had suggested, segregation and discrimination, not an unwillingness to use modern medicine or inherent racial traits, prevented African Americans from using health services and led to greater health problems. Indeed, many states, particularly those in the South, put resources towards

15 Pearl McIver, “Negro Nurses and the War Effort,” NNHN 11(3) 1943: 5-6; “Red Cross Emphasizes Home Nursing,” Philadelphia Tribune, April 8, 1944, 8; “Week emphasizes Health of Home,” Chicago Defender, April 8, 1944, 18; “‘Healthy Family’ Theme of Negro Health Week,” Chicago Defender, April 7, 1945, 14; “Home Nursing Stressed by American red Cross Negro Health Week,” Philadelphia Tribune, March 31, 1945, 8; “The American Red Cross and Home Nursing,” NNHN 13(1) 1945: 2-4.

16 Mott and Roemer, eds. Rural Health and Medical Care, 305-306.

17 Martha Eliot, “The Health of Our Negro Children,” 2, Folder 10, Box 13, NNHW, TA.

18 Mott and Roemer, eds. Rural Health and Medical Care, 306. 375 supporting and “properly training” midwives so that they would act under the purview of the medical establishment.19

The most controversial new group participating in NNHWM during World War II was Planned Parenthood. Formerly the American Birth Control League (the organization changed its name in 1942 in an effort to be less provocative), the group touted the idea that parents should decide when they had kids, distributed birth control, and helped women get abortions. At first glance, Planned Parenthood’s participation in NNHWM seems like an unlikely marriage. After all, the church often tied African American communities together and led NNHWM activities. While black churches consisted of a variety of sects, most opposed abortions, and only one of the many black members of the

National Advisory Council of the Planned Parenthood Federation was a church leader.20

However, when Planned Parenthood’s work tied into national security, it gained traction. As Emmett Scott, the Secretary at Tuskegee Institute during the Week’s early years and, by 1942, the Secretary of the Board for the Southern Education Foundation explained, “Family planning is as much a part of any complete program for national defense as the numberless other steps we are taking to preserve our nation.”21

19 Martha Eliot, “The Health of Our Negro Children,” 2, folder 10, box 13, NNHW, TA; Onnie Lee Logan as told to Katherine Clark, Motherwit: An Alabama Midwife’s Story (New York, NY: E.P. Dutton, 1989), especially 65-97; Margaret Charles Smith and Linda Janet Holmes, Listen to Me Good: The Life Story of an Alabama Midwife (Colubmus, OH: Ohio State University Press, 1996), 65-102. As Clark notes on xii, even by 1947, midwives in Alabama still attended 20% of all births and 50% of all black births in the state. It is also worth pointing out that this midwife training allowed medical authorities to control midwives and pushed the lay midwife out of the profession.

20 “Planned Parenthood Fits in With Health Week Theme,” Philadelphia Tribune, April 11, 1942, 8.

21 “Women’s Council for the Common Good,” Columbia State, April 12, 1942, in “THC, 1942,” 912, TA. 376

Planned Parenthood’s founder, Margaret Sanger, went further, asserting that family planning “can reduce the loss of life, health and happiness that spring from these conditions in the form of many deaths among Negro mothers and babies, frequent illnesses, tuberculosis, syphilis, mental disease, heart disease, illiteracy, child labor, overcrowding, ignorance and despair.”22 Sanger and others argued that many of the health issues African Americans faced stemmed from large families, which required greater resources than many parents could provide, thus forcing African American families into unhealthy situations. A reduction in family size would allow African

American families to maximize their resources and spend more per child.23

Sanger’s analysis was similar to that of other “liberal” and “progressive whites.” Her argument placed the onus on African Americans for their plight and ignored the segregation and discrimination that left many blacks with poor services or no services at all. She ignored the role race played as a determining factor in one’s life choices. Given the low income level of domestic servants, day laborers, and sharecroppers (the majority of blacks during this period), fewer children would not make a big difference.

In addition to family planning, Planned Parenthood offered other services to African

Americans. A. Philip Randolph, head of the Brotherhood of Sleeping Car Porters, explained that “Our present shortage and the great number of selective service rejections have shown the need for a generation of healthy babies born to healthy parents, who can

22 “Planned Parenthood Fits in With Health Week Theme: Race Leaders Endorse Vitally Important Program,” Philadelphia Tribune, April 11, 1942, 8.

23 “Women’s Council for the Common Good,” Columbia State, April 12, 1942, in “THC, 1942,” 912, TA; “Planned Parenthood Fits in With Health Week Theme: Race Leaders Endorse Vitally Important Program,” Philadelphia Tribune, April 11, 1942, 8. 377 give them the care and training they need.”24 Indeed Randolph’s warning about the draft rejections was a prime motivator for this newfound “health patriotism.” Estimates of draftees turned away for medical reasons ranged between 36%-45% overall, with 25% of

African American selectees testing positive for venereal disease as opposed to just 2% of whites.25

In this context, Planned Parenthood’s clinics, which provided not only pulmonary and venereal disease checks and information, but also the means for preventing a pregnancy until the parent could get treatment for these maladies, had great importance. Treatment improved the health of both the mother and future baby, especially important since the death rate for black mothers was twice that of whites and the rate for black babies was

60% higher.26 The promise of providing the next generation of African Americans with surer health footing encouraged Mabel K. Staupers, W. E. B. Du Bois, Walter White,

24 “Planned Families Aid Negro Health,” Birmingham Weekly Review, April 1, 1944, in “THC, 1944,” 368, TA; “Planned Families Aid Health,” Chicago Defender, April 8, 1944, 13; “Says Parenthood Should Receive Priority Rating,” Baltimore Afro-American, April 1, 1944, 10.

25 Thomas Parran, “”Today and Tomorrow in Public Health,” NNHN 13(2) 1945: 1-3, 2; F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: March 31 to April 7, 1946,” 1, FS 2.2: N313, 946, box FS 66, Records of the Government Printing Office, Record Group (RG) 149, National Archives and Records Administration, College Park, MD (NARA II); Gladyce H. Bradley, “Some Health Education Implications of the Physical Examinations of Negroes in World War II,” Journal of Negro Education (JNE) 16(2) Spring, 1947: 148-54, 148; E. R. Coffey, “Use Your Chances For Health,” April 2, 1942, 3, folder 5, box 14, NNHW, TA; ““National Negro Health Week in Mississippi,” NNHN 10(3) 1942: 21. In 1942 the number of rejections was closer to 50%, see Josephine Schuyler, “Nutrition and Racial Superiority,” Crisis, December, 1942: 380-381 and 397, 381.

26 “Planned Families Aid Negro Health,” Birmingham Weekly Review, April 1, 1944, in “THC, 1944,” 368, TA; “Planned Families Aid Health,” Chicago Defender, April 8, 1944, 13; “Says Parenthood Should Receive Priority Rating,” Baltimore Afro-American, April 1, 1944, 10; “Parenthood Group Joins Health Drive,” Philadelphia Tribune, April 1, 1944, 7; Mott and Roemer, eds. Rural Health and Medical Care, 70; E. R. Coffey, “Use Your Chances For Health,” April 2, 1942, 3, folder 5, box 14, NNHW, TA; Johanna Schoen, “Teaching Birth Control on Tobacco Road and Mill Village Alley: Race, Class, and Birth Control in Public Health,” in Silent Victories: The History and Practice of Public Health in Twentieth-Century America, eds., John W. Ward and Christian Warren, (New York, NY: Oxford University Press, 2007), 286. 378

Mary McLeod Bethune, and a host of other African American leaders to support Planned

Parenthood’s work.

In addition to the focus on health’s role in the war, NNHWM also promoted the idea that African Americans and whites had similar health concerns. Brown had the News republish articles with titles such as “Infantile Paralysis No Respecter of Race, Medical

Expert Says,” and “Is the Negro More Susceptible to Syphilis Than the White Man?”27

The answer to this latter question was “No.” These articles emphasized that whites and blacks faced the same kinds of health concerns. Dr. John P. Turner, an NMA member and former president, assured News readers that “syphilis and gonorrhea are not Negro diseases. While he [the African American] has acquired more than his share, the germs are not partial to any particular racial group.”28 Although such an opinion had become more mainstream, that Brown and the News chose to emphasize it during the war illustrated the effort to make health improvement interracial. Disease must not divide the races since they all faced the same ones.

The topic of health, even during the war, could not alter all attitudes. In the South,

Gunnar Myrdal found that it was the “habit of Southern whites to ostracize those white persons who work with Negroes….[and] devote themselves to Negro welfare.”29 Given this outlook, white physicians in the South supported training black physicians and nurses because such training aligned with the belief of Parran and other whites that, as one

27 “Infantile Paralysis No Respecter of Race, Medical Expert Says,” NNHN 12(1) 1944: 2; “Is the Negro More Susceptible to Syphilis Than the White Man?” NNHN 12(1) 1944: 5.

28 See also John P. Turner, “National Health Negro Wek – A Radio Broadcast,” NNHN, 12(3) 1944: 9-10 – originally in Journal of the National Medical Association (JNMA) 36(4) 1944: 118-119.

29 Myrdal, An American Dilemma, 646. 379 doctor put it, “no one quite understands the Negro problems as well as the Negro himself.”30 Additionally, having more black physicians would permit whites to pass on the responsibility for African American health and upkeep to blacks themselves and prevent whites from having to choose between humanitarian and professional responsibility, and social stigma. Myrdal described this argument as making an “appeal to

‘enlightened self-interest,’” although it also appealed to the racist attitudes of many whites who had little interest in interacting with or caring for blacks.31 For these reasons, white doctors supported the placement of black physicians and nurses into segregated hospitals.32

Historian David McBride notes that northern areas implemented similar practices as well, “while blacks….were on occasion admitted to some of the city’s several medical schools, this and other efforts to aid the training of black doctors and nurses were intended to reinforce rather than dismantle a separate health care network for the black and white communities of Philadelphia.”33 Even when health patriotism motivated both whites and blacks in the same community, depending upon the section of the country and the existence of race-based restrictions, it could manifest itself along segregated lines.

Both races participated in the Week’s activities in Asbury Park, New Jersey and in

Arcadia, Louisiana. However, in Asbury Park, an interracial coalition organized NNHW

30 “Negroes’ Health Discussed by Dr. Monteith,” April 3, 1943, in “THC, 1943,” 421, TA. On Parran’s agreement, see for example: Thomas Parran, “Public Health – The Base of Progress,” Opportunity, Fall, 1945, 195-197.

31 Myrdal, An American Dilemma, 171.

32 “Negroes’ Health Discussed by Dr. Monteith,” April 3, 1943, in “THC, 1943,” 421, TA.

33 McBride, Integrating the City of Medicine, Xvii. 380 events for whites and blacks to attend together.34 In Arcadia, the races remained separated throughout the Week. White and black schools submitted essays on immunization, but there were two award winners, one white and one black.35 They could not compete against each other for the same prize.

National Themes at the Local Level

During the war years, local weeks reflected the two themes of proper health as a war priority and the idea that all Americans faced similar health concerns regardless of race.

The Chicago Defender emphasized the former when it declared, “The demand for a strong, healthy, vigorous manpower to meet the needs of the war effort, both in the front lines and in the fields and factories, has given increased impetus to the various programs in the interest of health.”36 New Jersey’s organizers, as well as those in Baltimore,

Bristol, Virginia, and Delaware County, Pennsylvania made explicit note of this connection, with Delaware County’s leaders stating a goal of their week was “to stress the importance of health and health measures and their relation to present day defense efforts.”37 Writing his report on New Jersey’s Week, J. Earle Stuart was more specific:

34 “John A. Kenney, “A Plea for Interracial Cooperation,” JNMA 37(4), July 1945: 121- 124, 122.

35 A. Oppenheim, “Health Education in Action,” American Journal of Public Health and the Nation’s Health 33(11) 1943: 1939-1942, 1940.

36 “USDA Bureaus Give Rural Welfare Aid,” Chicago Defender, April 11, 1942, in “THC, 1942,” 911, TA.

37 J. Earle Stuart, “Report of National Negro Health Week in New Jersey,” 10(3) 1942: 25- 26; J. Earle Stuart, “Negro Health Work in New Jersey Summarized for National Negro Health Week,” NNHN 11(3) 1943: 12-14, 14; “Health Week in Delaware County, Pennsylvania,” NNHN, 10(3) 1942: 20; Charles C. Key, “Baltimore, Maryland, Maintains Good Health Week Record,” 381

“The importance of healthy people to carry on the war activities such as are needed in defense plants, and the change of manpower to women workers, plus caring for the sick at home due to crowded hospitals and the shortage of doctors, and the importance of eating the right food in spite of rationing, were discussed in our health meetings so that we too will be prepared to take our place in this national emergency.”38 Thus, physicians gave talks on first aid, fitness, syphilis, nutrition, and TB while connecting each topic to how it affected national defense.39

Fitness in particular became a renewed topic of emphasis for NNHWM during the war. Although Baltimore could no longer hold its marathon due to the limited time people had to organize and the restrictions on the use of metal which prevented the fabrication of a trophy, others promoted exercise in various forms.40 Jesse Owens went on a speaking tour in 1942, and others held classes or demonstrations for both boys and girls.41 All genders required exercise because, as F. Rivers Barnwell explained, “Before the war too many [boys and girls] were allowed to neglect their health and to grow into

NNHN 10(3) 1942: 13; “Editorial: National Negro Health Week, Bristol, Virginia,” NNHN 10(3) 1942: 29.

38 J. Earle Stuart, “Negro Health Work in New Jersey Summarized for National Negro Health Week,” NNHN 11(3) 1943: 12-13.

39 “Wilberforce Plans Health Conference,” Philadelphia Tribune, April 11, 1942, 10; “Doctors Take Active Part in Health Week Programs,” Philadelphia Tribune, April 18, 1942, 2; “Celebrates Health Week at Conference April 10,” Chicago Defender, April 4, 1942, 5.

40 Art Carter, “Annual health Week Marathon Called Off for ’42,” Baltimore Afro-American, April 18, 1942, 23.

41 “Jesse Owens Speaks At Y.W. Health Week,” Philadelphia Tribune, April 11, 1942, 10; “Jesse Owens Speaker For Health Week,” Philadelphia Tribune, April 11, 1942, 17; “Health meeting Set at ‘Force,” Baltimore Afro-American, April 11, 1942, 19; J. Earle Stuart, “Negro Health Work in New Jersey Summarized for National Negro Health Week,” NNHN 11(3) 1943: 12-14, 14; “YWCA Marks Health Wk. With Demonstrations By Various Gym Units,” Philadelphia Tribune, April 18, 1942, 2. 382 frail adults – liabilities to society and to themselves.”42 They were a liability to society because now that these children had become adults, they did not have the proper health to pass the selective service exam or work in the factories.

By 1945, exercise had become such a priority in health that a National Negro Health

Week editorial touted physical fitness, along with good housing, as representing “the foundation without which nothing lasting can be built.”43 Even though the war inspired this increased interest in physical fitness, Barnwell contended that “There is no reason why student bodies of high schools and colleges in peacetime should not be made up of sturdy, healthy youths of the type now in the armed forces.”44 Such virile black men and women would gain greater economic self-determination since they would miss little work due to sickness.

For F. Rivers Barnwell, there was a direct connection between religion and physical fitness. As he explained in his 1945 sermon, the image of Jesus Christ as “a frail man, without muscles…is not the Christ who worked at the carpenter’s bench, who could fell trees and carry the hewn timber…who had to dig in the rocks when foundation was necessary for building.”45 According to Barnwell, the Son of G-d on earth was strong and formidable, radiating health. “Do you suppose a weak, unhealthy personality could say to

42 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 2 to April 9, 1944,” 2, folder 10, box 13, NNHW, TA.

43 “Let Us Learn to Live,” NNHN 13(1) 1945: Back Cover.

44 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 2 to April 9, 1944,” 2, folder 10, box 13, NNHW, TA.

45 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 1 to April 8, 1945,” 1, FS 2.2: N313, 945, box FS 66, Records of the Government Printing Office, RG 149, NARA II. 383 a sick man, ‘walk,’ and have any effect on him? No.”46 Notably, Barnwell attributed

Christ’s health not only to physical fitness, but also to his parents who “followed all the laws of purification and cleanliness and definitely contributed to the robust health and growth of the child.”47 For Barnwell and other NNHW leaders and speakers, parents were the first line of defense in a community wide effort to inculcate proper health techniques and practices in children.48

Nutrition also became an important topic for NNHWM during the war years. Already on the NNHW radar, it became a more significant issue when a 1937 League of Nations study found that almost 90% of African Americans had a diet below the standards of proper nutrition.49 In 1942, the War Manpower Commission found little improvement.

While about 50% of African Americans living on farms had a “good” diet since they could raise their own food, less than 20% of those living in cities could say the same.

This latter statistic was especially problematic given that urban areas were where most war work took place. The Commission also noted that one-third of all city diets,

46 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 1 to April 8, 1945,” 1, FS 2.2: N313, 945, box FS 66, Records of the Government Printing Office, RG 149, NARA II.

47 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 1 to April 8, 1945,” 1, FS 2.2: N313, 945, box FS 66, Records of the Government Printing Office, RG 149, NARA II.

48 See for example: F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 2 to April 9, 1944,” 1-3, folder 10, box 13, NNHW, TA; F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 1 to April 8, 1945,” 1-4, FS 2.2: N313, 945, box FS 66, Records of the Government Printing Office, RG 149, NARA II; Martha Eliot, “The Health of Our Negro Children,” 1-3, folder 10, box 13, NNHW, TA.

49 Schuyler, “Nutrition and Racial Superiority,” 381. Josephine Schuyler is a particularly fascinating character in American history. She passed as an African American woman, married a black man, and darkened her own skin. For more on her see Carla Kaplan, Miss Anne in Harlem: The White Women of the Black Renaissance (New York, NY: Harper Perennial, 2013), especially 83-165. 384 regardless of race, could be classified as “bad,” and Josephine Schuyler of The Crisis noted that, “the majority of city colored folk are in this group.”50 Such habits contributed to the perceptions of the time that laborers were poor eaters and that African Americans were the worst of the bunch.51

The discrimination in employment and education that left African Americans in low paying jobs helps to explain this situation. Without their own farms, improving a diet required greater financial resources than many could afford. However, this situation had the potential to create even greater animosity towards blacks since propaganda at the time connected poor nutrition to, in effect, aiding Hitler.52 Weak, unhealthy soldiers could not defeat Germany.

To fight the dietary battle, local NNHW leaders encouraged blacks to join in Red

Cross programs on nutrition, taught basic nutritional concepts in schools, and even reviewed healthy recipes for the rationed kitchen.53 These tactics were reminiscent of those used with European immigrants decades earlier, though they occurred on a much wider scale and within the context of a national campaign. Indeed, the Red Cross programs and other efforts at nutritional instruction targeted all Americans. The News

50 Schuyler, “Nutrition and Racial Superiority,” 380.

51 Charlotte Biltekoff, Eating Right in America: The Cultural Politics of Food and Health (Durham, NC: Duke University Press, 2013), 67.

52 For more on the connection between nutrition and WWII see Biltekoff, Eating Right in America, especially 67-74.

53 See for example “Week emphasizes Health of Home,” Chicago Defender, April 8, 1944, 18; “Tasty School Lunches Aid Billikens Health,” Chicago Defender, April 8, 1944, 16; “Summary of Health Week Activities in Halifax County, North Carolina,” NNHN, vol. 10, no. 4, October-December, 1942, 8; “Red Cross Emphasizes Home Nursing,” Philadelphia Tribune, April 8, 1944 8; “Hold Health Week Program at Bennett,” Chicago Defender, April 21, 1945, 15; “Annual Observance Opens April 4-11; Health and Housing Movie Tuesday,” Des Moines Bystander, April 1, 1943, in “THC, 1943,” 420, TA. 385 also participated in this nutritional war. In a list of the five ways to improve health, it put

“Eat Right” in the first position, ahead of proper rest and exercise, keeping clean, and seeing a doctor regularly. The News also noted specific foods that would allow one to

“eat right,” such as leafy vegetables, whole-grains, and beans.54 Here again, NNHW returned to the original Week’s efforts to promote individual practices as the key ingredients to good health.

In addition to improving basic health during war, the act of practicing proper nutrition could also be a way to display one’s support of the war effort. As the historian Charlotte

Biltekoff puts it, “lessons in eating right were a means of promoting home-front morale,” and “of delineating wartime ideals of good citizenship.”55 As such, organizers in

Alabama, Florida, and Louisiana encouraged African Americans to plant

“victory/defense gardens,” small gardens outside of homes and in public parks. While these gardens would not produce enough food to feed a family, they were a symbol not only of following wartime rationing, but also of participating in efforts to aid the war effort by easing the pressure on the public food supply. These gardens transcended race.

The government encouraged both whites and blacks to tend to them, making these

NNHW gardens a black display of unity with whites in winning the war. Orlando’s

African Americans went even further. The Orlando Morning Sentinel noted that during the city’s Week, “all negroes will sign pledges for full cooperation” in this activity, giving concrete evidence to their health patriotism.56

54 “Just by Keeping Well, You Can Help Win This War,” NNHN 11(1) 1943: 7.

55 Biltekoff, Eating Right in America, 10.

386

The second theme promoting the similarity of health issues across the races also manifested itself locally during the war. The Connecticut State Health Department asserted that “In this locality…he [the black man] is subject to the same general community health problems and opportunities for improving health as the white man.”57

Organizers in Illinois came to a similar conclusion after health officials found that the whooping cough and infant death rates of blacks in the state had decreased at a greater rate than that of whites. The report on NNHW in Illinois stated, “This would suggest that the non-white population might eventually overtake the white and be able to maintain as favorable a statistical health record as does the white.”58 Leaders in Maryland looked to the present instead of the future, “marked contrasts between the whites and Negroes are due, for the most part, to differing sanitary standards. When these standards are equal, the contrasts in the morbidity and mortality rates for the two races tend to disappear.”59 Such arguments in support of racial equality in health sharply contrasted with those less than

30 years earlier.

Non-Medical Roles in NNHWM

56 “Colored Citizens Will Observe Health Week,” Greenville Advocate, in “THC, 1943,” 417, TA; “Health Week Observance,” in “THC, 1943,” 416, TA; “Negro health Week To Clean Up Orlando Yards From April 5-12,” Orlando Morning Sentinel, April 1, 1942, in “THC, 1942,” 910, TA; I. N. Givens and M. D. Huggins, “Health Week Achievements in East Baton Rouge Parish, Louisiana,” NNHN 13(3) 1945: 5-6.

57 “Negro Health Week Observance Asked by Connecticut State Health Department,” NNHN 10(3) 1942: 27.

58 “Negro Health Week in Illinois,” NNHN 11(3) 1943: 10.

59 “Negro Health Week Program in Maryland,” NNHN 12(3) 1944: 8. 387

In 1943, the Des Moines Bystander echoed the vision of Monroe Work and Booker T.

Washington when it asserted that the Week provided, “every community, home and family...with information easy to read and understand and directions easy to follow.”60 To achieve this goal, Brown changed the NNHW materials. The school leaflets made during the war all contained between 10 and 12 specific tips on how to maintain personal hygiene. Although these tips included the need to get a regular physical exam and vaccinations, they also noted practices those without medical training could implement.

These tips were similar to the ones included in the bulletins of the 1920s as limited war resources encouraged leaders to return to health basics to support the nation’s health. The leaflets explained that hand washing should occur before meals and after using the toilet.

Daily eating habits included milk and fresh fruit and vegetables. Although the leaflets did not include specific reasoning for these recommendations, the return to an emphasis on personal practices was noteworthy. The 1942 leaflet even included tips on first aid administration.61 The lack of available physicians due to the war also meant Brown and the NNHW Committee had to reorient the Week’s messaging to include basic health education that lay professionals could decipher and teach.

Wartime constraints on spending and resources forced Brown into other changes. The

PHS reduced the bulletin to four pages in 1942 and 1943, and two pages in 1944, as war

60 “Negro Health Week April 6-14,” Des Moines Bystander, March 25, 1943, in “THC, 1943,” 420, TA.

61 For 1940s leaflet examples, see “National Negro Health Week, Twenty-eighth Observance: April 5-12, 1942,” “National Negro Health Week, The Thirtieth Observance: April 2- 9, 1944,” “National Negro Health Week, The Thirty-first Observance: April 1-8, 1945,” FS 2.2 N31 942-945, in FS 2.2N:16-FS 2.2:N88/2/969, box FS 66, Records of the Government Printing Office, Printed Archives of the United States, RG 287, NARA II. 388 restrictions became more pervasive and the PHS looked to reduce costs.62 The smaller bulletin still maintained the continuity of those of the late 1930s. It contained information on how to organize, the themes of each day of the Week, and photographs illustrating

NNHW activities from around the country.63 As with the leaflets, while the photographs contained images of medical professionals conducting physical exams and nurse graduations, they also showed locals organizing cleanups and otherwise participating. As the News put it, when it came to health education, everyone had a role, from the physicians and nurses to local teachers, and even “a salesman selling paper cups.”64 With newspapers and radio programs focused on the war, Brown had to turn to other methods of publicity. The primary candidates to get the word out about the Week, as for the original Week, were black ministers, and the PHS mailed copies of the NNHW sermon to generate excitement about NNHW.

Thus, when in early 1943 the Printing and Duplicating Committee refused to make the 3,000 copies the PHS requested, deeming it “not necessary,” the Week’s leaders objected strongly.65 Within two weeks, the Committee received a follow-up letter asking

62 The bulletin briefly expanded to 16 pages in 1945, before returning to 4 pages from 1946-1949.

63 “National Negro Health Week, Twenty-eighth Annual Observance: April 5-12, 1942,” PHS, Washington, D.C., 1942, folder 5, box 14, NNHW, TA; “National Negro Health Week, Twenty-ninth Observance: April 5-12, 1942,” PHS, Washington, D.C., 1943, folder 1, box 8, NNHW, TA; “National Negro Health Week, The Thirtieth Observance: April 2-9, 1944,” PHS, Washington, D.C., 1944, FS 2.2 N312 944, box FS 66, Records of the Government Printing Office Printed Archives of the United States, RG 149, NARA II; “National Negro Health Week, The Thirty-first Observance: April 1-8, 1945,” PHS, Washington, D.C., 1945, FS 2.2:N312 945, box FS 66, Records of the Government Printing Office Printed Archives of the United States, RG 149, NARA II.

64 “What is Health Education,” NNHN 11(2) 1943: 5.

389 that it reconsider. However, Roscoe Brown did not write it. Instead, the white Assistant

Surgeon General E. R. Coffey wrote in defense of printing the sermon. While Coffey did much of the coordinating when it came to PHS publications, his vigorous defense of the sermon indicated the importance the PHS as a whole gave to its production.

Coffey’s letter appealed to the sermon’s utility, asserting that it had been “a most effective means of enlisting the cooperation of ministers.” These ministers would in turn reach “the largest regular lay audience with much needed popular health instruction.”

According to Coffey, the sermon was a tool for both publicity and teaching. The letter continued, stressing the connection between the sermon and patriotism, arguing that it was “an essential service for the maintenance and promotion of the morale of the people.” Lastly, Coffey noted that in addition to the PHS’ perspective, “large numbers of churches and organizations have attested to its [the sermon’s] value.” In concluding,

Coffey defended Brown and the Office of Negro Health Work. He pointed out that the

Office had “cooperated willingly and effectually in the regulations and plans for conservation of materials and services…making only…reasonable requests for the conduct of the essential duties and responsibilities of the office.” From the PHS’ perspective, the sermon, written for ministers, non-health experts, was “essential” to the work it wanted to accomplish during the war: maintaining a healthy supply of factory workers and soldiers.66

65 Taylor H. McCauley to D. L. Cooke, February 18, 1943, folder “Nat’l Negro Health Week,” box 675, Records of the Public Health Service, RG 90, NARA II.

66 E. R. Coffey to Taylor H. McCauley, March 3, 1943, folder “Nat’l Negro Health Week,” box 675, Records of the Public Health Service, RG 90, NARA II. 390

In addition to the sermon, the accessibility of all NNHW materials remained a concern during the war. Early on, the PHS moved quickly to provide funds to support

NNHWM. Just four weeks after Pearl Harbor, the PHS appropriated $700 for publishing

NNHW posters, bulletins, and leaflets.67 However, keeping the costs and prices of these

NNHW materials low became more difficult as the war continued and, by 1943, the

Government Printing Office threatened to increase both. This situation created difficulties for NNHW since higher prices, as Coffey pointed out, “would practically prohibit the use of the National Negro Health Week publications by thousands of persons and groups which have very limited means.”68

Part of the appeal of NNHW was that people could obtain health information for essentially no cost via health talks, films, and radio broadcasts. Almost all of these activities involved NNHW partnering with another organization. The NNHW publications were the only concrete materials the NNHW Committee provided for participants to refer to. They were the way to know the daily NNHW themes and how to participate and organize a campaign. Their traditionally low cost (prices ranged from $1-

$3/100 posters and $1.25-$2/100 bulletins) meant that organizers could obtain them and start a campaign without a significant financial expenditure. The NNHMC also often had a limited number it could distribute for free.69

67 E. R. Coffey to Daniel Masterson, December 30, 1941, folder “Nat’l Negro Health Week,” box 675, Records of the Public Health Service, RG 90, NARA II.

68 E. R. Coffey to Alton P. Tisdel, November 26, 1943, folder “Nat’l Negro Health Week,” box 675, Records of the Public Health Service, RG 90, NARA II.

69 Robert Moton to City Health Officer, January 27, 1930, folder 1, box 1, NNHW, TA; Robert Moton to Superintendent of Documents, Government Printing Office, December 12, 1928, Folder 1252, Box 156, “Robert Moton General Correspondence,” TA; E. R. Coffey to Alton P. 391

A higher cost would require more advanced planning to raise funds to get these materials. With the war a top priority, long-term planning around NNHW was unlikely, decreasing participation. Additionally, past organizers now needed more money for the same number of materials. Their limited NNHW budgets could not handle a price increase, and the decrease in publicity items could lead to depressed turnout. As such,

Coffey made a special appeal to the Government Printing Office about this issue as well, noting the “educational value and usefulness of, the National Negro Health Week publications.” This is another example of Coffey interceding on the behalf of, and touting the accomplishments of, the Office of Negro Health Work and the necessity of NNHW during the war.

NNHW Statistics

Restrictions on paper and printing were not the only ways that NNHWM felt the impact of the war. The statistical data the Week collected, published annually in the

News, was also affected. This data was useful in assessing where to allocate resources, as well as in identifying what health activities received the most and least interest, analysis which would spur changes in the following year’s campaign. The data on participation was also useful to Brown as evidence of the overall importance of the campaign and buy- in of the African American public.

The war changed not only the amount of resources devoted to the campaign, but also the amount of time people had to make the reports to the national NNHM Committee.

Tisdel, November 26, 1943, folder “Nat’l Negro Health Week,” box 675, Records of the Public Health Service, RG 90, NARA II; “Negro Health Week Set For April 4-11,” Chicago Defender, February 13, 1942, 13. 392

Beginning in 1943, NNHW data appeared in large round numbers rather than specific figures. For example, the News reported that for the 1942 Week, 125,775 people attended

1,866 health exhibits and that there were 52,212 insect and rodent control activities. Such detail attests to an exact accounting of the activities from meticulous reports submitted by local NNHW organizations. By way of comparison, the figures for the same categories in

1943 were: 200,000; 2,000; and 35,000.70

The alteration is understandable. Again, the war meant that the government had to be careful about allocating resources. Additionally, as noted earlier, the Week created an opportunity for propaganda and instilling patriotism. Relying exclusively on specific figures during the war, a war which could prevent people from participating in the Week due to more pressing obligations, had the potential to create negative publicity if numbers decreased. To that end, the News only published the data from the previous year, limiting one’s ability to identify a pattern. Additionally, organizers could more easily coax rounded estimates towards a positive interpretation than would be the case with precise data.

However, even the best estimates could not deny that participation in the Week declined during the war. Notwithstanding the Red Cross and Planned Parenthood joining the campaign, by the end of the war in 1945, many of NNHW’s statistics had decreased significantly from their pre-war numbers in 1941. The percentage of lectures and radio talks given (-45% and -19% respectively), pieces of literature produced (-70%), films shown (-51%), and newspaper articles written (-38%) all declined. This drop

70 “Statistical Report: National Negro Health Week - 1942,” NNHN 10(3) 1942: 2-3; “National Negro Health Week Awards, Year 1943,” NNHN 11(3) 1943: 1. 393 corresponded with a decrease in lecture, movie, and health exhibit attendance (-50%, -

29%, and -17% respectively). Unsurprisingly, the decrease in the numbers of activities led to a decline in the overall figures for the number of participants, moving from more than 4 million participants in 1941 to just over 3 million in 1945.71

Not all the news was bad for NNHWM. Circulation of the News remained stable, between 3,500 and 4,000, and the Week’s ability to still entice millions to participate indicated continued interest in the campaign.72 Indeed, Brown thought that the 1943

Week “resulted in the most successful Health Week program and year-round planning of community health activities since the twenty-fifth anniversary in 1939.”73 Exactly what criteria Brown based his boast on was unclear, but his attitude is noteworthy. Brown and the NNHW Committee could also take pride in expanding NNHWM to 45 states from 36, and in increasing the number of communities participating to 12,500, a remarkable growth of 83%.74

71 “Statistical Report: National Negro Health Week - 1941,” NNHN 9(3) 1941: 2-3; “Statistical Report: National Negro Health Week - 1942,” NNHN 10(3) 1942: 2-3; “National Negro Health Week Awards, Year 1943,” NNHN 11(3) 1943: 1; “National Negro Health Week Awards, Year 1944,” NNHN, 12(3) 1944: 1; “National Negro Health Week Awards, Year 1945,” NNHN 13(3) 1945: 1.

72 Annual Reports of the United States Public Health Service: for the Fiscal Years 1941- 1942, 1942-1943 (Washington, D.C., Government Printing Office, 1943), 27, 106; Annual Report of the United States Public Health Service: for the Fiscal Year 1944 (Washington, D.C., Government Printing Office, 1944), 21.

73 Roscoe C. Brown to E. R. Coffey, April 19, 1943, folder “Nat’l Negro Health Week,” box 675, Records of the Public Health Service, RG 90, NARA II.

74 “Statistical Report: National Negro Health Week - 1941,” NNHN 9(3) 1941: 2-3; “Statistical Report: National Negro Health Week - 1942,” NNHN 10(3) 1942: 2-3; “National Negro Health Week Awards, Year 1943,” NNHN 11(3) 1943: 1; “National Negro Health Week Awards, Year 1944,” NNHN, 12(3) 1944: 1; “National Negro Health Week Awards, Year 1945,” NNHN 13(3) 1945: 1. 394

Some of the credit for the Week’s expansion must go to the NNHW Committee itself, which remained remarkably stable during the war. It consisted of 14 members, including three women, and 10 members of the Committee served for the entire duration of the war.75 Brown continued to work as Chairman and R. Maurice Moss as secretary. In addition to long-time serving members T. M. Campbell and Barnwell, the Committee’s members represented a broad spectrum of health care interests. These included members of the National Negro Insurance Association (NNIA) and other insurance companies; the

Negro Organization Society of Virginia; the National Dental Association; a representative each from Morgan College and Dillard University, along with a couple of others from various educational foundations; at least one physician; and NACGN representative Mabel Keaton Staupers.

Such cohesion helped NNHW navigate the war by keeping its main goals the same.

That is, promoting basic cleaning up, as well as supporting medical professionals. Efforts around cleanliness were largely similar to those that came before.76 Despite having less money and time to organize talks and movies or get statements of support, and restrictions on radio air waves, the NNHW program saw increases in participation in

75 These members were: Roscoe Brown, R. Maurice Moss, T. M. Campbell, F. Rivers Barnwell, Mabel Keaton Staupers, Millard T. Dean, A. W. Dent, Charles C. Key, Shellie T. Northcutt, and C. L. Townes.

76 “USDA Bureaus Give Rural Welfare Aid,” Chicago Defender, April 11, 1942, in “THC, 1942,” 911, TA; “Colored Citizens Plan for Health Week Here,” Greenville Advocate, April 2, 1942, in “THC, 1942,” 909, TA; “Negro Health Week – April 5-12,” Laurel Call, April 6, 1942, in “THC, 1942,” 914, TA; “Health Week Observance,” in “THC, 1943,” 416, TA; “Colored Citizens Will Observe Health Week,” Greenville Advocate, in “THC, 1943,” 417, TA; Dennis A. Bethea, “Cleanliness,” Baltimore Afro-American, April 1, 1944, 2; “National Negro Health Wk Observance Here,” Kenansville Times-Herald, April 28, 1944, in “THC, 1944,” 370, TA; I. N. Givens and M. D. Huggins, “Health Week Achievements in East Baton Rouge Parish, Louisiana,” NNHN 13(3) 1945: 5-6. 395 activities it had thrown by the wayside.77 The total number of plant and flower projects rose 297% during the war years, meaning that the average community went from conducting four such projects a year to eight. The number of cleanup projects aside from homes and lots increased as well, though less dramatically, by 132%.78 The war’s labor needs increased demand for unskilled labor, which lowered the poverty rates throughout the country and increased wages at the bottom of the pay scale.79 Thus, some communities, particularly urban ones, had more resources to support this work.

Necessity serves to explain the apparent about-face on planting and cleaning projects.

Whereas the PHS had encouraged medical professionals to take the lead in organizing local weeks, many doctors, dentists, and nurses had new duties during the war that occupied their time. This is not to say that health experts did not participate in the Weeks during these years. Writing for the Baltimore Afro-American, Dr. Dennis A. Bethea asserted that, “Any physician, dentist or nurse would gladly give a talk before any club or church group.”80 Indeed, the number of clinics grew by 35% and attendance by 117% as

77 Although not support from local officials. See for example: “Topeka Kansas, Observes and Commends Negro Health Week,” NNHN 11(4) 1943: 18; Roscoe C. Brown to E. R. Coffey, April 19, 1943, folder “Nat’l Negro Health Week,” box 675, Records of the Public Health Service, RG 90, NARA II; I. N. Givens and M. D. Huggins, “Health Week Achievements in East Baton Rouge Parish, Louisiana,” NNHN 13(3) 1945: 6; “City to Observe Negro health Week April 1-8,” Birmingham News, March 22, 1945, in “THC, 1945,” 800, TA; “John A. Kenney, “A Plea for Interracial Cooperation,” JNMA 37 (4), July 1945: 121-124.

78 “Statistical Report: National Negro Health Week - 1941,” NNHN 9(3) 1941: 2-3; “Statistical Report: National Negro Health Week - 1942,” NNHN 10(3) 1942: 2-3; “National Negro Health Week Awards, Year 1943,” NNHN 11(3) 1943: 1; “National Negro Health Week Awards, Year 1944,” NNHN, 12(3) 1944: 1; “National Negro Health Week Awards, Year 1945,” NNHN 13(3) 1945: 1.

79 Robert D. Plotnick, Eugene Smolensky, Eirik Evenhouse, Siobhan Reilly, “The Twentieth Century Record of Inequality and Poverty in the United States,” Institute for Research on Poverty, Discussion Paper no. 1166-98, July 1998, 17.

396 annual Weeks continued the push for African Americans to take advantage of existing health services in their communities.81 Wartime health patriotism also contributed to this invigorated participation at clinics.

Yet without medical professionals shaping the Week at the highest local levels, community leadership returned, in some part at least, to those outside the medical establishment. With lay professionals in charge, local Weeks often circled back to the core principles of cleaning up, washing up, and other ways to improve health that people could accomplish without the supervision of a medical expert. This return did not include giving blacks the tools to improve health without medical professional input. Brown and the NNHW Committee still championed health messaging from the medical establishment. Those who participated in cleanup activities did so more as a way to join in a campaign of racial solidarity and demonstrate their health patriotism than to learn specific practices to improve their health.

When promoting medical practices, popular targets for the Week’s goals continued to be venereal disease and TB, as well as increasing the awareness of immunization, clinic use, and the utility and importance of physicians.82 Barnwell’s sermons even regularly referred to Jesus Christ as “The Great Physician” to reinforce the latter point.83

80 Dennis A. Batha[sic], “Health Week,” Baltimore Afro-American, March 31, 1945, 5. Note the paper spelled Dr. Bethea’s name incorrectly here.

81 “Statistical Report: National Negro Health Week - 1941,” NNHN 9(3) 1941: 2-3; “Statistical Report: National Negro Health Week - 1942,” NNHN 10(3) 1942: 2-3; “National Negro Health Week Awards, Year 1943,” NNHN 11(3) 1943: 1; “National Negro Health Week Awards, Year 1944,” NNHN, 12(3) 1944: 1; “National Negro Health Week Awards, Year 1945,” NNHN 13(3) 1945: 1. For emphasis on community health services, see for example E. R. Coffey, “Use Your Chances For Health,” April 2, 1942, 3, folder 5, box 14, “National Negro Health Week Collection,” TA; “1945 National Negro Health Week Recorded Radio Broadcast,” NNHN 13(1) 1945: 2.

397

As part of the increasing emphasis on nutrition, care of the teeth started to receive more attention. The New Jersey State Department of Health reported that dental problems led to the rejection of 200,000 of the first 2 million men examined for the armed forces.84

Such a situation led NNHWs to increase their interest in dentists and dental clinics. In

1943, the Shelby County Dental Society in Arkansas organized a set of clinical demonstrations as a precursor for NNHW. Dentists from Arkansas, Oklahoma, and

Tennessee drove in to see the demonstrations and, ostensibly, to start conversations about their participation during NNHW.85

The next year, Brown, a trained dentist, appealed to dentists directly, asserting their importance in fighting the concerns African Americans had about trusting medical professionals. Since dentists often did not see emergency cases, “the setting and the patient’s presence lend themselves more readily to instruction and prevention as well as

82 Charles C. Key, “Baltimore, Maryland, Maintains Good Health Week Record,” NNHN, 10(3) 1942: 13; “National Negro Health Week in Mississippi,” NNHN 10(3) 1942: 21; “Report of National Negro Health Week in New Jersey,” NNHN 10(3) 1942: 25; “Negro Health Week Observance Asked by Connecticut State Health Department,” NNHN 10(3) 1942: 27; “Summary of Health Week Activities in Halifax County, North Carolina,” NNHN 10(4) 1942: 8; “Health Week Extended to Bay County, Florida,” NNHN 13(3) 1945: 7.

83 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 4 to April 11, 1943,”1, folder 7, box 14, “National Negro Health Week Collection,” TA; F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 1 to April 8, 1945,” 3, FS 2.2: N313, 945, box FS 66, Records of the Government Printing Office, RG 149, NARA II; F. Rivers Barnwell, “Annual Sermon for National Negro health Week: March 31 to April 7, 1946,” 1, FS 2.2: N313, 946, box FS 66, Records of the Government Printing Office, RG 149, NARA II. Barnwell used this phrase in just one sermon prior to WWII, see F. Rivers Barnwell, “National Negro Health Week,” Atlanta Daily World, March 19, 1938, in “THC, 1938,” 306, TA.

84 Wilda R. Smith, “Need for Dental Care Stressed,” Philadelphia Tribune, April 7, 1945, 17.

85 See for example, “Negro Health Week – April 5-12,” Laurel Call, April 6, 1942, in “THC, 1942,” 914, TA; Belma Daniel Tucker, “National Health Week is Observed Here by Negro Community,” April 15, 1943, in “THC, 1943,” 421, TA; “Shelby County Dental Group Holds Clinic,” Chicago Defender, April 11, 1942, 13. 398 to treatment and correction.”86 This significant role meant that the small number of black dentists, just 1,471 according to the 1940 census, with just over 600 located in the South, needed to be on the front lines of efforts to improve black health, the most prominent of which was NNHW.87

During the war, nurses also continued to take on prominent roles in the Week. Nurses led the Week in South Jersey in 1942 and featured as speakers in Camden’s 1945 Week, while Louisville kicked off its 1944 Week by honoring the only nurse supervisor in the

City-County Health Department.88 More significantly, Brown gave time in the 1945

NNHW radio broadcast to Mabel K. Staupers and the topic of nurses. Much like Brown the year before, she used this opportunity to assert the importance of the profession “It is no exaggeration to say that the nurse is indispensable in any health activity.”89 She also used the broadcast to advocate for more nurses, promoting the social and economic opportunity that nursing gave to young black women.

By the end of the war, her efforts within NNHW and as NACGN Executive

Secretary, combined with the war’s emergency need for more nurses, had begun to bear fruit. In 1945 there were 2,600 black nursing students, a 135% increase from 1939.90

86 Roscoe C. Brown, “The Dentist and Public Health,” NNHN 12(1) 1944: 9.

87 U.S. Bureau of the Census, Sixteenth Census of the United States: 1940 – Population: The Labor Force (Washington, D.C.: U.S. Department of Commerce, 1943), 88; Karen Kruse Thomas, “The Hill-Burton Act and Civil Rights: Expanding Hospital Care for Black Southerners, 1939-1960,” Journal of Southern History 72(4) November 2006: 832-870, 826-827.

88 J. Earle Stuart, “Report of National Negro Health Week in New Jersey,” NNHN 10(3) 1942: 25; “Camden TB Assn. to Mark natl. Negro Health Week,” Philadelphia Tribune, March 31, 1945, 17; “Branch Village Holds Program,” Philadelphia Tribune, April 14, 1945, 15; “Merit Citation for Ky. Nurse,” Baltimore Afro-American, April 29, 1944, 10.

89 “1945 National Negro Health Week Recorded Radio Broadcast,” NNHN 13(1) 1945: 3.

399

Although not nearly enough to meet the race’s needs, many perceived this growth in the nursing student body as a portent of the things to come on the road towards improving black health.91 Again, such thoughts focused on expanding the role of the medical professional in African American health, not on giving the average African American the ability to improve health on his or her own.

With few resources available throughout the country, local leaders got creative about how they presented NNHW. In New Jersey, where the Negro Health Program of the State

Department of Health ran the Week, the Week’s leaders turned back towards grassroots efforts and the Des Moines Bystander’s call for easily comprehensible health information.

Recognizing that small towns in the Southern part of the state had few organizations capable of generating large audiences for health talks, the Department encouraged local leaders to go house-to-house distributing literature. For those who could attend health talks, the Department organized discussions to enhance listener comprehension. In 1942,

“All of the health meetings were augmented by motion pictures, the distribution of literature, and the question and answer period so that the audience may clear up any questions they may have on the subject.”92 The Department used similar tactics when it came to X-rays, immunizations, and vaccinations, holding demonstrations and explaining the need for all of these practices.93 These tactics attempted to make African Americans

90 Darlene Clark Hine, Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890-1950 (Bloomington, IN: Indiana University press, 1989), 152.

91 Mott and Roemer, eds. Rural Health and Medical Care, 343.

92 J. Earle Stuart, “Report of National Negro Health Week in New Jersey,” NNHN 10(3) 1942: 25. The report for the next year indicates a similar approach. J. Earle Stuart, “Negro Health Work in New Jersey Summarized for National Negro Health Week,” NNHN 11(3) 1943: 13.

400 more comfortable with these medical practices. They also recognized the discomfort some African Americans had with health experts and their methods. In so doing, leaders hoped to leave blacks feeling that health professionals acknowledged and responded to

African American concerns, building greater trust between blacks and the medical community.

NNHW 1946-1950

After World War II, President Truman announced as part of his post-war goals

“health security for all, regardless of residence, station, or race—everywhere in the

United States.”94 Given all the participation and interest that the Week generated from government officials, including the military and executive branch, Truman’s announcement appeared to augur a new age of expansion for NNHW. However, the campaign did not fulfill this ambition.

Almost immediately, the Week’s leaders recognized the difficulty of building upon the popularity of the Week as the government reallocated resources after the war.

Truman’s efforts led to Congressional debates about health in terms of access, insurance, and policy, but not to greater PHS funding for the Week.95 Without the war, the

93 J. Earle Stuart, “Report of National Negro Health Week in New Jersey,” NNHN 10(3) 1942: 25. The report for the next year indicates a similar approach. J. Earle Stuart, “Negro Health Work in New Jersey Summarized for National Negro Health Week,” NNHN 11(3) 1943: 13.

94 “RADIO SPEECH MATERIAL for the Year 1946 Observance of the NATIONAL NEGRO HEALTH WEEK: March 31 to April 7, 1946,” Public Health Service, Federal Security Agency, 1, 1h 287, College of Physicians of Philadelphia, Philadelphia, PA (CPP). The statement comes from Harry Truman “Special Message to the Congress Recommending a Comprehensive Health Program,” November 19, 1945.

95 George Rosen, A History of Public Health, Expanded Ed., (Baltimore, MD: The Johns Hopkins University Press, 1993), 452; W. Montague Cobb, “Removing Our Health Burden,” 401 connection between health and national defense, the “health patriotism” that Brown and the PHS had used to coerce participation, was now far less impactful.

In particular, the PHS began to turn its attention away from the Week, especially in terms of its financial aid. Without the wartime restrictions that reduced the PHS produced

NNHW bulletin from eight pages to two, Brown and the NNHWC could have reasonably expected the bulletin to expand back to its prewar size. However, each bulletin from

1946-1950 was only four pages. Additionally, the bulletin now came in a stock format, Figure 7 with only the front cover changing significantly each year. The pictures on pages two and three always showed rote NNHW activities. Most common were images of medical professionals leading clinics, talks, and meetings, or photos illustrating the work of communities. Two articles promoting general health, or tying personal health to that of the community, always accompanied these images. The back cover contained the daily themes of the Week along with the advice about Back Cover of the 1948 NNHW Bulletin what to do on each day, as well as a final picture.96 These restrictions on design, content, and length were all similar to the way the PHS produced the bulletin during the war and

Crisis, September, 1946: 268-270, 282-283, 268; W. Montague Cobb, “Special Problems in the Provision of Medical Services for Negroes,” JNE, vol. 18, no. 3, Summer, 1949: 340-345, 345.

96 “National Negro Health Week, Special Objective: A Healthy Home in a Healthy Community, Health Education and Health Services,” PHS, Washington, D.C., 1946, FS 2.2:N312 946; “National Negro Health Week, Special Objective: ‘Community-wide Cooperation for Better Health and Sanitation,” PHS, Washington, D.C., 1947, FS 2.2:N312 947; “National Negro Health 402 indicated the PHS’ disinterest in returning the NNHWM campaign to its previous funding levels.

The NNHW radio address also felt the impact of less PHS support. Prior to 1946, a particular person always delivered the address on air, and Brown often reprinted it in the

News. After the war, the NNHW Committee stopped this practice. Instead, for 1946 and

1947, it produced “suggested speech material” that it sent to local organizers so they could create their own radio addresses. “Suggested speech material” included copy that

“Cooperating Health Week groups and Health Week speakers may use…for information and suggestions in preparing talks for local radio programs.”97 In place of a national broadcast and message, the Week now featured hundreds of local broadcasts with a variety of health messages. Many of the content recommendations involved rote elements of NNHW materials, such as citing recent poor health statistics for African Americans and suggesting that the entire community needed to participate to see an improvement.

The 1946 material alluded back to original arguments for the Week. It pointed out that economics should be a huge motivator in the war on ill health since, “Health conserves the family earnings and sickness drains the family budget.”98 The advice also emphasized

Week, April 4-11, 1948,” PHS, Washington, D.C., 1948, FS 2.2:N312 948; “National Negro Health Week, April 3-10, 1949,” PHS, Washington, D.C., 1949, FS 2.2:N312 949; “National Negro Health Week: Time To Take Inventory: What and How; Whence and Whither?” PHS, Washington, D.C., 1950, FS 2.2:N312 950; all in box FS 66, Records of the Government Printing Office Printed Archives of the United States, RG 149, NARA II.

97 “RADIO SPEECH MATERIAL for the Year 1946 Observance of the NATIONAL NEGRO HEALTH WEEK: March 31 to April 7, 1946,” Public Health Service, Federal Security Agency, n/p, 1h 287, CPP. See also “FACT SHEET FOR THE 1947 NATIONAL NEGRO HEALTH WEEK: March 30 – April 6, 147,” Public Health Service, Federal Security Agency, 1-3, 1h 287, CPP.

403 that greater use of medical professionals and health care facilities would improve both black and white health outcomes.99

By 1948 and 1949, the PHS explained that “Because of budgetary restrictions, a radio transcription for use of local stations…. cannot be provided.”100 What had been affordable, even during wartime, no longer interested the PHS. As previous chapters have discussed, many cities in the past had conducted radio programs during the Week so the concept was not novel. However, the national broadcast was something that those participating in the Week could experience together, connecting people from different areas to their NNHWM work. Without it, local campaign differences were more likely to appear and decrease the sense that the Week represented a cohesive national movement.

To encourage local organizers to create radio programs, the NNHW Committee provided local leaders with suggestions based on its national program. As Algernon

Jackson had suggested years earlier, entertainment was an important element in transmitting health messages. The NNHWC advised that broadcast speakers use “the

98 “RADIO SPEECH MATERIAL for the Year 1946 Observance of the NATIONAL NEGRO HEALTH WEEK: March 31 to April 7, 1946,” Public Health Service, Federal Security Agency, 1, 1h 287, CPP.

99 “RADIO SPEECH MATERIAL for the Year 1946 Observance of the NATIONAL NEGRO HEALTH WEEK: March 31 to April 7, 1946,” Public Health Service, Federal Security Agency, 1-2, 1h 287, CPP; “FACT SHEET FOR THE 1947 NATIONAL NEGRO HEALTH WEEK: March 30 – April 6, 147,” Public Health Service, Federal Security Agency, 1-3, 1h 287, CPP; “FACT SHEET FOR THE 1948 NATIONAL NEGRO HEALTH WEEK: April 4- April 11, 1948,” Public Health Service, Federal Security Agency, 1-2, 1h 287, CPP; “FACT SHEET FOR THE 1949 NATIONAL NEGRO HEALTH WEEK: March 30 – April 6, 1949,” Public Health Service, Federal Security Agency, 1-3, 1h 287, CPP.

100 “RADIO BROADCAST SUGGESTIONS for the year 1948 Observance of the NATIONAL NEGRO HEALTH WEEK: April 4 to April 11, 1948,” Public Health Service, Federal Security Agency, 1, 1h 287, CPP; “RADIO BROADCAST SUGGESTIONS for the Year 1949 Observance of the NATIONAL NEGRO HEALTH WEEK: April 3 to April 10, 1949,” Public Health Service, Federal Security Agency, 1, 1h, 287, CPP. 404 utmost simplicity, sincerity, and brevity” when on the air.101 As in the past, the goal of the broadcast was to impart clear and easy to understand health messages, not long medical lectures. It also encouraged the use of music during the broadcast. The purpose of the music was to attract listeners who might stay tuned for the health talk after the song. Hence, the Committee recommended “that a musical program should be bright and well-balanced. No one type of music or one composer should predominate.”102

Additionally, the NNHWC noted that different types of audiences listened to the radio at different times: families on Sundays; children and teenagers during Saturday mornings; and program leaders should keep a specific audience in mind.103

However, it was up to the local organizers to pick the particular audience to target for the radio address. It was also up to local leaders to decide on the music most suited to their audience and to identify what “brevity” meant for their own communities. Without specific examples of what a NNHW broadcast should look like, local leaders had great leeway in the creation of these programs.

101 “RADIO BROADCAST SUGGESTIONS for the year 1948 Observance of the NATIONAL NEGRO HEALTH WEEK: April 4 to April 11, 1948,” Public Health Service, Federal Security Agency, 2, 1h 287, CPP; “RADIO BROADCAST SUGGESTIONS for the Year 1949 Observance of the NATIONAL NEGRO HEALTH WEEK: April 3 to April 10, 1949,” Public Health Service, Federal Security Agency, 2, 1h, 287, CPP. See also “RADIO SPEECH MATERIAL for the Year 1946 Observance of the NATIONAL NEGRO HEALTH WEEK: March 31 to April 7, 1946,” Public Health Service, Federal Security Agency, n/p, 1h 287, CPP.

102 “RADIO BROADCAST SUGGESTIONS for the year 1948 Observance of the NATIONAL NEGRO HEALTH WEEK: April 4 to April 11, 1948,” Public Health Service, Federal Security Agency, 2, 1h 287, CPP.

103 “RADIO BROADCAST SUGGESTIONS for the year 1948 Observance of the NATIONAL NEGRO HEALTH WEEK: April 4 to April 11, 1948,” Public Health Service, Federal Security Agency, 1, 1h 287, CPP; “RADIO BROADCAST SUGGESTIONS for the Year 1949 Observance of the NATIONAL NEGRO HEALTH WEEK: April 3 to April 10, 1949,” Public Health Service, Federal Security Agency, 1, 1h, 287, CPP. 405

The NNHW sermon also reflected the decreased priority the PHS gave to the Week and the worries about the long-term viability of the campaign. Brown continued to send the NNHW sermon Barnwell created to ministers and organizers, but by 1947 its content had changed. Prior to that year, the NNHW sermon usually included some health problems facing African Americans along with general advice that correlated with the

NNHW theme of that particular year. Additionally, the traditional sermon reinforced the importance of medical professionals and that “Both the individual and the community have a responsibility in protecting health.”104 The idea was that everyone should join together to support the Week. The 1947 sermon contained many of these same themes, but it also had elements designed to reinvigorate and rededicate its listeners to the cause.

One element aimed to animate listeners was the invocation of Booker T. Washington.

Radio addresses and NNHW materials often depicted Washington as the Week’s founder, using his fame to entice greater participation. This name-dropping occurred most often on the day of his birth as a suggestion for using NNHW to take time to celebrate “the

Wizard of Tuskegee.” Yet Barnwell included few discussions of Washington in his sermons. Barnwell wrote for ministers and sought health heroes and motivation largely from the Bible. Instead of Washington, his sermons venerated the work and thoughts of

“the Great Physician,” Jesus Christ, as well as those of the Apostle Paul and Moses.105

104 F. Rivers Barnwell, “Annual Sermon for National Negro health Week: March 31 to April 7, 1946,” 2, FS 2.2: N313, 946, Box FS 66, Records of the Government Printing Office, RG 149, NARA II. See also for example F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: April 2 to April 9, 1944,” 2, folder 10, box 13, NNHW, TA; F. Rivers Barnwell, “National Negro Health Week,” Atlanta Daily World, March 19, 1938, in “THC, 1938,” 306, TA.

105 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week,” March 30 to April 6, 1941, 1-2, FS 2.2:N313, box FS 66, Records of the Government Printing Office, RG 149, NARA II; F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: March 30 to April 406

However, in 1947 Barnwell used Washington’s work on the Week as a motivational tool. He noted that “The greatest monument to his life and service is erected in the hearts of the human family during this HEALTH WEEK.”106 According to Barnwell, the best way to celebrate this African American hero was to participate in the Week. Barnwell laid this particular emphasis on thick: “Long live the memory of Booker T. Washington and the principles for which he stood. And may we all live better and do better because he had a vision of his people’s future and translated his vision into practical programs and helping hands.”107 The sudden use of Washington’s legacy illustrated Barnwell’s concern about the longevity of the Week.

Barnwell also suggested that the Church, a major organizing tool of NNHW, was not doing its part to promote the Week. As Barnwell stated in his sermon, “On this Health

Sunday of 1947 it is expected that the Christian Church will lead out in instruction for

Better Health and Sanitation [the 1947 NNHW theme], and urge the cooperation of all citizens in securing better health measures, better homes and better communities, and, altogether, whatever may be needed for fuller personal and community health for all.”108

Never before had Barnwell felt the need to declare what he “expected” of the black

6, 1947,” 2, FS 2.2: N313, 947, box FS 66, Records of the Government Printing Office, RG 149, NARA II.

106 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: March 30 to April 6, 1947,” 2, FS 2.2: N313, 947, box FS 66, Records of the Government Printing Office, RG 149, NARA II.

107 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: March 30 to April 6, 1947,” 2, FS 2.2: N313, 947, box FS 66, Records of the Government Printing Office, RG 149, NARA II.

108 F. Rivers Barnwell, “Annual Sermon for National Negro Health Week: March 30 to April 6, 1947,” 2, FS 2.2: N313, 947, box FS 66, Records of the Government Printing Office, RG 149, NARA II. 407 clergy. Since Barnwell designed the sermon for a minister to read it as is, such a statement could have caused some embarrassment for the reader if his Church had not already organized NNHW activities. More importantly, using the sermon to set forth the expectations the NNHW Committee had for the Church reemphasized the importance of the Church in the Week, and the feared decline of its support. In this way the NNHWC took on an organizing role at the local level, instructing specific locals how to participate, a more heavy-handed approach than in the past.

Local organizers also recognized that the postwar world presented challenges for

NNHW. In 1946, Dr. Dennis A. Bethea noted that “It may not be possible to put on the intensive week’s program as was done in the early years.”109 In Baltimore especially those words appeared prescient. That year, the Baltimore campaign restarted its marathon race, which in previous years had generated vast interest from across the county. Yet the count at the start was only 15 runners, significantly fewer than the 28 who competed in

1941, and a far cry from the 94 who registered for the race in 1927.110

The NNHWC appeared to recognize Bethea’s and other’s concerns when it listed

“clean-up and home beautification,” along with “health education,” and “clinical activities” as “the three principal observance features” of the Week.111 More specifically,

109 Dennis A. Bethea, “National Negro Health Week,” Baltimore Afro-American, March 30, 1946, 14.

110 “Morganite Cops Balto. Marathon,” Baltimore Afro-American, April 20, 1946, 14; “Interracial Competitors, Baltimore Maryland, 1946, National Negro Health Week Marathon,” NNHN, vol. 14, no. 3, July-September, 1946, image, 17; Art Carter, “Joe Hines Breaks High School Record,” Baltimore Afro-American, April 26, 1941, 20; “John Carroll Wins Marathon,” Baltimore Afro-American, April 30, 1927, 15.

111 “32nd National Health Week Observance Set,” Baltimore Afro-American, March 23, 1946, 3. 408 the Department of Agriculture focused its NNHW activities on “Holding nutrition clinics, painting and screening of homes, improving the water supply, making better provisions for sewage disposal, and building sanitary privies.”112 In Lepanto, Arkansas, organizers at a local school had students make home visits to help residents improve sanitation, somewhat similar to what the Atlanta school district and others did in the early years of

NNHW.113 It is noteworthy that so many of these activities (painting and screening homes, working on sewage disposal and building sanitary privies) were items that had been goals of the Week’s original campaign in 1915. Their return to prominence in the campaign indicated a renewed focus on low-cost solutions to improve black health within a campaign that itself had to adjust to the PHS’ low-spending.

At the local level, many communities participated as they had in the past. Community goals for the Week looked fairly similar to how they always had. They focused on health education, fighting tuberculosis and venereal disease, organizing vaccinations, X-rays, blood tests, and clinics for adults and children.114 Appeals to whites to participate in

NNHW remained focused on white self-interest, and tied better black health to improved

112 “Extensive U.S. Program Features Health Week,” Philadelphia Tribune, March 30, 1948, 14; “Special Drive Planned for Negro Health Week,” Baltimore Afro-American, April 3, 1948, 16.

113 “Lepanto,” Chicago Defender, May 1, 1948, 18.

114 See for example: Thomas Parran, “Health Goals,” JNMA 38(6) November 1946: 213- 216; “Thirty-third Annual Observance, National Negro Health Week: March 30 – April 6, 1947 (Press Release, #3),” U.S. Public Health Service, Federal Security Agency, 1-2, 1h 287, CPP; “Fact Sheet for the 1947 National Negro Health Week: March 30 – April 6, 1947,” U.S. Public Health Service, Federal Security Agency, 2-3, 1h 287, CPP; Francis J. Weber, “Tuberculosis and the Negro,” Public Health Reports, 63(14) April 2, 1948: 425-426; Leonard A. Scheele, “Negro Health Week and the Health of the Negro,” NNHN 17(3) 1949: 5-6; Barbara S. Prigmore, “One Minute Interview,” Philadelphia Tribune, April 6, 1946, 6; “Health Service Warn Against Dreaded Germs,” Philadelphia Tribune, April 6, 1946, 19; “4 Diseases Targets for Health Week,” Baltimore Afro-American, March 22, 1947, 7; “Don’t Say We Didn’t Tell You,” Chicago Defender, April 5, 1947, 13; “Photo Standalone 15 – No Title,” Chicago Defender, April 19, 1947, 10; “Health Week Program to Focus on Family,” Chicago Defender, February 21, 1948, 3. 409 white health.115 Dr. Bethea also argued that blacks should join in more health movements and programs whites led, “We must co-operate with those who are working might and main to stamp out tuberculosis, infantile paralysis, venereal diseases and those who are promoting child welfare.”116 All the health efforts Bethea listed affected blacks at a much higher rate than whites. From Bethea’s perspective, NNHW was not just about generating white interest in black health, but also about building black interest in other programs that would support their health. More African Americans living in big cities meant blacks now had a chance to participate in a much wider variety of health campaigns, and influence those campaigns for their own benefit, than ever before.

The cooperating black and white organizations that local groups could look to for support remained largely the same and the Red Cross remained one of the most influential. Although the Red Cross had ended its blood segregation program, it still accepted the racist premise that African Americans could better reach other African

Americans. The Red Cross hired a Howard University nutrition teacher to improve the ways it taught proper nutrition and diet to African Americans. Similar to efforts other groups made to teach European immigrants, she focused her teaching on practical lessons regarding proper food choices.117 Other Red Cross work during NNHW included instruction on accident prevention, water safety, and recruiting volunteer nurses.118

115 “Proclaim March 31 – April 7 National Negro Health Week,” Chicago Defender, March 23, 1946, 21; “32nd National Health Week Observance Set,” Baltimore Afro-American, March 23, 1946, 3; “Dr. Drew Cites Need of Allround Health,” Philadelphia Tribune, April 23, 1949, 3.

116 Dennis A. Bethea, “Health Week is April 3 to 10: Here’s What you can Do This Week and All Year,” Baltimore Afro-American, April 9, 1949, B9.

410

However, most Red Cross efforts surrounding NNHW continued to concentrate on getting African American women to enroll in its home nursing classes on “Mother and

Baby Care,” “Family Health,” and “Care of the Sick.” While these courses were not specifically for African Americans, the Red Cross designed the classes for those living in areas that lacked adequate medical facilities. To better engage with African American communities, the 1949 Red Cross participation in NNHW involved giving non-nurses the training to teach a course that nurses had exclusively taught in the past, “Care of the

Sick.” As the Red Cross’ Eleanor Adams explained, allowing non-nurses to teach basic nursing care would put the country “a step nearer the ideal that every family in America have one home nurse.”119

Here, the Red Cross tried to make basic health more attainable for the average

African American through elementary and practical health instruction. Allowing non- nurses to teach such a course provided more people with the opportunity to learn about health. It also demystified some medical practices and gave blacks, especially those in rural areas, the ability to take greater control of their health needs. They did not have to wait for a doctor or nurse to begin treatment when sick. They also gained a greater appreciation for the work these health professionals could do when called, providing

117 “Red Cross Supports Negro Health Week,” Philadelphia Tribune, April 6, 1946, 9; “Citizens Aid Red Cross Program,” Chicago Defender, March 30, 1946, 19; “Negro Participation in the American red Cross Program,” NNHN 14(3) 1946: 11.

118 “Red Cross Supports Negro Health Week,” Philadelphia Tribune, April 6, 1946, 9; “Citizens Aid Red Cross Program,” Chicago Defender, March 30, 1946, 19; “Negro Participation in the American red Cross Program,” NNHN 14(3) 1946: 11; “Health Week Observance Spotlights Volunteer Services of Women,” Baltimore Afro-American, April 5, 1947, 8.

119 Eleanor Adams, “Red Cross Widens Opportunities for Nursing Aid and Instruction,” NNHN 16(4) 1948: 1-4, 4. 411

African Americans with another opportunity to reassess their feelings towards professional medical practices.

To have an award-winning NNHW campaign required a few vital elements. Involving children and schools in the Week remained a key component of most winning campaigns.120 The 1947 winner of the award, Georgia’s Savannah and Chatham

Counties, immunized 1,000 students against typhoid, and had blood tests done on more than 3,000.121 In order to effectively organize useful programs for children in the area, the cooperation of a variety of community groups and people was essential, another criteria for judging a Week. The final major element was to submit a report with as much data as possible. The News noted that Durham, North Carolina’s winning NNHW report for 1946

“contains 22 items descriptive of various kinds of accomplishment,” and in 1949 the

News similarly explained that the report by St. Landry Parish, Louisiana was “carefully organized and assembled” and “contains statistics.”122

An emphasis on data was not unusual, but in the context of the postwar NNHW, it was significant. As discussed earlier in this chapter, Brown took to using estimates, rather than precise data, to calculate national NNHW participation during the war. The postwar stress on figures and counting implied that Brown continued to face a deficit in such information. His lack of data made assessing the Week problematic.

120 “All-America Trophy Award for 1946,” NNHN 14(4) 1946: 9; Ruth Sumner, “What Savannah and Chatham County, Georgia, Did for Their 1947 Negro Health Week,” NNHN 15(3) 1947: 5-6, 6; “All-America Trophy Award for 1948,” NNHN 16(3) 1948: 5.

121 Ruth Sumner, “What Savannah and Chatham County, Georgia, Did for Their 1947 Negro Health Week,” NNHN 15(3) 1947: 5-6, 6.

122 “All-America Trophy Award for 1946,” NNHN 14(4) 1946: 9; “All-America Trophy to St. Landry Parish, Louisiana,” NNHN 17(4) 1949: 5-6: 6. 412

Health studies conducted during this period indicated that African American health continued to improve. Between 1931 and 1945, the African American tuberculosis and syphilis rates decreased by almost 50% and 25% respectively.123 These reductions still left blacks with TB and syphilis rates three and five times higher, respectively, than the rates for whites.124 However, the overall African American death rate continued to decline. While the white death rate stayed at about the same during the war at 10.1-

10.7/1000, the African American death rate decreased from 25/1000 in 1900 to 13.8/1000 by 1940 and 11.1/1000 by 1946.125 By 1950, the average African American could expect to live more than 60 years, almost double the figure in 1904. The life expectancy gap by race had decreased as well, from white’s living 15 years longer than blacks in the early

1900s to less than eight.126 Such life expectancy for African Americans would have greatly impressed Monroe Work, who had thought 50 years of life expectancy by 1963 an ambitious goal.127

There are many factors that helped African Americans improve their health during the

1940s. One was the general increase in emphasis on health that occurred during this

123 “Thirty-third Annual Observance, National Negro Health Week: March 30 – April 6, 1947 (Press Release, #3),” U.S. Public Health Service, Federal Security Agency, 1, 1h 287, College of Physicians of Philadelphia, Philadelphia, PA (CPP).

124 “Thirty-third Annual Observance, National Negro Health Week: March 30 – April 6, 1947 (Press Release, #3),” U.S. Public Health Service, Federal Security Agency, 1, 1h 287, CPP.

125 U.S Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970 (Washington, D.C.: U.S. Department of Commerce, 1975), 59.

126 U.S Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970 (Washington, D.C.: U.S. Department of Commerce, 1975), 55.

127 Jessica P. Guzman, “Monroe Nathan Work and His Contributions,” Journal of Negro History, 34(4) 1949: 428-461, 452; Monroe Work, ed., Negro Year Book: An Annual Encyclopedia of the Negro 1914-1915 (Tuskegee, AL: The Negro Year Book Publishing Company, 1915), 320. 413 period. As Gunnar Myrdal explained, “Any impartial efforts to reduce sickness and death in the nation will have much more effect on Negroes than on whites simply because

Negroes have much more preventable and curable disease to begin with.”128 Wartime demands for healthy soldiers and workers gave African Americans greater access to medical professionals and led local and state governments to expand services to blacks.

Hospitals and facilities that had only served whites began to limit segregation to particular wards and floors.129 Between 1936 and 1950, the black infant mortality rate decreased by almost 50% and the black maternal mortality rate reduced by over 75%.

The biggest factor in these decreases was that many more blacks began giving birth in hospitals or at least in the presence of medical professionals.130

Additionally, during and after World War II, sociologist Reynolds Farley found that

“the income of blacks increased much faster than did the cost of living.” Expanding his research to all non-white male workers, Farley found that between 1939 and 1950, their annual median income increased from less than $500 to $1,800.131 These changes in income allowed African Americans to spend more on health care and meant that they could afford to live in less crowded apartments. However, restrictive covenants,

128 Myrdal, An American Dilemma, 163.

129 Thomas, “The Hill-Burton Act and Civil Rights,” 826.

130 U.S Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970 (Washington, D.C.: U.S. Department of Commerce, 1975), 57; Reynolds Farley, Growth of the Black Population: A study in Demographic Trends (Chicago, IL: Markham Publishing Co., 1970), 206-245; Thomas, “The Hill-Burton Act and Civil Rights,” 831, 847. States began heavily regulating midwives during this period as well so as to include them as professionals, see Onnie Lee Logan as told to Katherine Clark, Motherwit: An Alabama Midwife’s Story (New York, NY: E.P. Dutton, 1989), x-xii; Margaret Charles Smith and Linda Janet Holmes, Listen to Me Good: The Life Story of an Alabama Midwife (Colubmus, OH: Ohio State University Press, 1996), 65-67, 115.

131 Farley, Growth of the Black Population, 74; 236. 414 redlining, and blockbusting real estate practices reduced the health benefits of many of these opportunities. For example, in Baltimore the rate of black home ownership increased 194% between 1940 and 1950, but 42% of Baltimore’s black housing units lacked private baths and 22.4% had no running water.132

The continued improvement of black health supported the contention of African

American leaders that blacks were not inherently dirty or diseased, and that they could understand and utilize health education for their benefit. From this perspective, the

National Negro Health Week Movement had a demonstrable impact on improving health outcomes. As C. C. Spaulding, the president of North Carolina Mutual Life Insurance

Company, put it: “In the fight to conquer disease, Health Week has proved an able ally.”133 Yet less than four years later, the PHS terminated the Week as many of

Spaulding’s black professional colleagues turned on NNHW.

Black Professionals vs. NNHW

As World War II came to an end, the NAACP and other organizations promoting black welfare changed their strategy in the struggle for civil rights. Prior to the war, most of these groups had concentrated on equalization. While unhappy with the concept of

132 Arnold R. Hirsch, Making the Second Ghetto: Race and Housing in Chicago 1940- 1960 (New York, NY: Cambridge University Press, 1983), 5, 30; Otis Dudley Duncan and Beverly Duncan, The Negro Population of Chicago: A Study of Residential Succession (Chicago, IL: The University of Chicago Press, 1957), 96; Lisa Levenstein, A Movement Without Marches: African American Women and the Politics of Poverty in Postwar Philadelphia (Chapel Hill, NC: The University of North Carolina Press, 2009), 11; Antero Pietila, Not in My Neighborhood: How Bigotry Shaped a Great American City (Chicago, IL: Ivan R. Dee, 2010), xi, 98, 110; David McAlister, “Realtors and Racism in Working-Class Philadelphia, 1945-1970,” in African American Urban History since World War II, eds., Kenneth L. Kusmer and Joe Trotter (Chicago: University of Chicago Press, 2009), 123-141.

133 C. C. Spaulding, “Good Health, Long Life Span Parallel, Spaulding Declares,” Baltimore Afro-American, April 12, 1947, 5. 415

“separate but equal” handed own in the Plessy v. Ferguson decision, they often made the pragmatic decision to emphasize the “equal” part of the ruling. They asserted that many of the separate facilities created for African Americans, such as separate schools and hospitals, were unequal to those for whites, violating the principles of “separate but equal.” The goal was not to integrate the schools or hospital, but instead to get funding, supplies, and other necessities to African American institutions so that they would be equal to those of their white counterparts. Some even thought that this increased funding might lead to integration due to the high cost of maintaining separate schools with equal funding. The NAACP led the charge here, winning cases that desegregated the University of Maryland’s Law School and allowed a black student to attend the Law School at the

University of Missouri.134 In health this focus promoted the expansion of Negro Hospitals and, with the support of the NMA, the successful passage of the Hill-Burton Act.135

However, the war encouraged the NMA and NAACP to shift their focus to integrationism. They sought to capitalize on the utility African Americans had demonstrated in their efforts during the war, noting that if they were good enough to die for their country they were good enough to have access to the same rights as white

Americans. The increased income the war provided African Americans gave these groups greater financial backing to challenge segregation. The NAACP filed lawsuits that led to the end of “white primaries” that had stopped African Americans from voting, and

134 Geena Rae McNeil, Groundwork: Charles Hamilton Houston and the Struggle for Civil Rights (Philadelphia, PA: University of Pennsylvania Press, 1983), 138-156.

135 Thomas, “The Hill-Burton Act and Civil Rights,” 837-840. 416 lawsuits that led to the termination of racially restrictive housing covenants.136 These victories eventually paved the way for the Brown v. Board of Education of Topeka,

Kansas decision in 1954 that overturned “separate but equal.”

In health, integrationists focused on dismantling the “negro medical ghetto.”137 The

African American physician Paul B. Cornely’s first suggestion in his article on how

“Negro Health Problems Can be Solved” advocated abandoning the “quota system in allocating health facilities to the Negro,” noting that “it seems elemental that health services must be furnished in relation to the needs of any group, rather than on a basis of its ratio in the population.”138 If African Americans faced greater health concerns than whites, then they should receive more medical resources to support health improvements.

Problematically, as Cornely noted, much of the medical profession’s resources were still inaccessible to African Americans. The number of hospital beds available to blacks was between 15% and 20% less than the population required. The ratio of black doctors to black patients was 1:3,400, much greater than the 1:750 doctor to patient ratio in the nation overall. The Journal of Negro Education estimated that to meet the national ratio the race needed 15,000 more African American physicians. Yet in 1948-1949, medical schools enrolled fewer than 700.139 Part of this problem stemmed from the policy of

136 U.S. Reports: Smith v. Allwright, 321 U.S. 649 (1944); U.S. Reports: Shelley v. Kraemer, 334 U.S. 1 (1947).

137 Gamble, Making a Place for Ourselves, 182; “John A. Kenney, “A Plea for Interracial Cooperation,” JNMA 37(4), July 1945: 121-124; “Paul B. Cornely, “Negro Health Problems Can be Solved,” NNHN 13(2) 1945: 7.

138 “Paul B. Cornely, “Negro Health Problems Can be Solved,” NNHN 13(2) 1945: 7.

139 “Study of Negro Health Status Reveals Progress, But Much More Improvement Needed,” NNHN 18(1) 1950: 18-19. The 1950 census records slightly different figures but the discrepancy is the same. It records a 1:900 doctor-patient ratio in the whole country and counts 417

Southern medical schools, one-third of all medical schools in the country, which refused to accept black students.140 The situation facing dental hygiene was even worse for

African Americans. The ratio across the country was 1 dentist for every 1,865 people; for black dentists and patients it was 1:8,745.141

With far fewer black medical professionals available than the population needed, it was imperative that black physicians continue to fight the racism in the medical profession. In 1948, the American Medical Association (AMA) voted down a resolution that “No constituent association exclude from membership any physician for other than professional or ethical reasons.”142 Instead, county medical societies retained the ability to exclude membership based on race. AMA affiliates in 17 Southern states and

Washington, D.C. had discriminatory laws that barred blacks from membership. Since most hospitals continued to require AMA membership to work, these restrictions severely limited employment opportunities for black doctors.143 The black physician W. Montague

Cobb argued that this dependence on the white medical establishment for acceptance and

3,630 black doctors giving African Americans a doctor-patient ratio of 1:4,100. See U.S. Bureau of the Census, Statistical Abstract of the United States, 1955 (Washington, D.C.: U.S. Department of Commerce, 1955), 33; U.S. Bureau of the Census, United States Census of Population: 1950 - Employment and Personal Characteristics (Washington, D.C.: U.S. Department of Commerce, 1953), 1B-29.

140 Edward H. Beardsley, A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South (Knoxville, TN: University of Tennessee Press, 1987), 253.

141 “The National Health Problem,” NNHN 16(1) 1948: 1; Paul B. Cornely, “Distribution of Negro Dentists in the United States (With tables),” NNHN 16(1) 1948: 13-15, 13.

142 Herbert Morais, The History of the Negro in Medicine (New York, NY: Publishers Company, 1967), 133; John Dittmer, The Good Doctors: The Medical Committee for Human Rights and the Struggle for Social Justice in Health Care (New York, NY: Bloomsbury Press, 2009), 7. The AMA officially ended discrimination in all its societies in 1968.

143 “Color and the AMA,” Newsweek, 32, July 12, 1948: 46-47. 418 opportunity made “numerous Negro doctors…timorous about asserting independence of the American Medical Association.”144

The racism of many white health professionals affected medical practice as well.

Cobb noted that even in 1949, when most physicians had accepted the concept of disease as colorblind, “we may find trained public health officials whose utterances and official acts indicate a concept of disease as a racial problem.”145 In historian Lisa Levenstein’s examination of African American women in postwar Philadelphia, she found that “Many working-class African Americans had received discriminatory treatment from white doctors and other medical professionals who had either refused to accept them as patients or had provided inadequate and demeaning care.”146 Cobb and others argued that these negative interactions with white medical professionals risked undermining the health gains blacks had made.

The NAACP was, in Cobb’s words, “most acutely aware” of how health improvements could impact the African American community.147 President Truman’s focus on health and a national health bill encouraged the NAACP to reexamine its role in

African American health. Led by Dr. Cobb, the NAACP’s Walter White, and others, the

NAACP joined with the NMA in the late 1940s to advocate for the desegregation of

144 W. Montague Cobb, “Special Problems in the Provision of Medical Services for Negroes,” JNE 18(3) Summer, 1949: 340-345, 342.

145 W. Montague Cobb, “Special Problems in the Provision of Medical Services for Negroes,” JNE 18(3) Summer, 1949: 340-345, 342. See also for example Milton M. James, “Comparative Mental Abilities of Negroes and Whites,” The Negro History Bulletin, 15, April, 1952: 137-141.

146 Levenstein, A Movement Without Marches, 160.

147 W. Montague Cobb, “Removing Our Health Burden,” Crisis, September, 1946: 268- 270, 282-283, 268. 419 hospitals and other segregated practices in health care. This effort was a continuation of the NAACP’s new effort to systematically challenge racial segregation. It also represented a significant turnaround from both groups’ late 1930s support of the Hill-

Burton Act. As a member of both organizations, Cobb had substantial influence and published two monographs for the NAACP to raise awareness of how discrimination affected black access to health care services and professional opportunities.148 Cobb pushed the groups to fight segregation even when there was greater funding for segregated institutions.149

According to Cobb, the arguments against integration were: “segregative arrangements preserve the peace, that progress is being made under them and that the proponents of fundamental changes only ‘set things back.’”150 Segregation supporters could cite the improved health statistics for blacks since the early 1900s as evidence “that progress is being made” under segregation. However, as Cobb explained, these improvements still left African Americans a generation or more behind their white counterparts in terms of health outcomes, life expectancy and facilities. The last was due to the “hand-me-down” process that many white communities used to treat and care for their African American neighbors. Whites often reserved news hospitals for their race and gave the previous white hospital to blacks. Whites could then blame blacks for any

148 The two monographs were: Medical Care and the plight of the Negro (1947); and Progress and Portents for the Negro in Medicine (1948). W. Michael Byrd and Linda A. Clayton, An American Health Dilemma: A Medical History of African Americans and the Problem of Race, vol. 2 (New York: Routledge, 2002), 256.

149 Beardsley, A History of Neglect, 245-272.

150 W. Montague Cobb, “Special Problems in the Provision of Medical Services for Negroes,” JNE 18(3) Summer, 1949: 340-345, 341. 420 failures at the dilapidated, but “new,” to them, facility now under their control. African

Americans who protested against getting the old white facility risked being attacked for denouncing opportunities for their race.151 After all, wasn’t it better to have an old hospital than none at all?

Yet such circumstances left African Americans using the worst health care facilities.

The Hill-Burton Act addressed this problem to some degree. Under the Act, building a new white hospital required construction of a new black hospital as well, and both had to receive the same financial support. States used the law’s $13 billion in federal funds and matching grants to build more than 10,000 health facilities, with space for almost 500,000 beds. In practice, the Act led to the creation of numerous biracial hospitals that served both races, but segregated them by wards and floors. Many of the facilities that received federal funds under Hill-Burton were built in rural areas without hospitals, expanding access to medical professionals for both blacks and whites. Hill-Burton even gave black doctors and nurses more opportunities to train. However, Cobb argued that Hill-Burton’s support of segregation still limited black health improvement. For example, hospital authorities could still turn black patients away if the black ward was full, even if the white ward was not.152 The best way to improve black health was to integrate medical schools, hospitals, and health care.

NAACP Executive Secretary Walter White’s 1947 letter to President Truman captured much of Dr. Cobb’s thinking. With the weight of the NAACP’s legislative

151 W. Montague Cobb, “Medical Care and the Plight of the Negro,” Crisis, July, 1947: 201-211, 204-205.

152 Thomas, “The Hill-Burton Act and Civil Rights,” 823, 847, 859, 868-869. 421 victories against segregated practices behind him, White asserted that “federal aid…[should go to] needy students of all races in standard accepted medical schools” and that “Negro medical students should be admitted to all medical schools.”153 Cobb went even further when it came to medical education, calling on the black medical schools at

Howard and Meharry to admit white students.154 The goal was to create a system in which all races had an equal opportunity to health education. As White put it, “No Jim

Crow scholarships are desirable or wanted.”155

When it came to legislation on health, White felt similarly, “Negroes should share…to the identical degree and in the identical manner as all other citizens.”156 The

“Negro hospital,” was no longer desirable. As the NMA’s and NAACP’s demands for integration grew, a National Negro Health Week advocating the health needs of a particular race began to appear obsolete.157

153 Walter White to Harry S. Truman, October 21, 1947, 2, folder 095 “National Association for the Advancement of Colored People,” box 25, Records of the Department of Health, Education and Welfare, RG 235, NARA II.

154 W. Montague Cobb, “Medical Care and the Plight of the Negro,” Crisis, July, 1947: 201-211, 202.

155 Walter White to Harry S. Truman, October 21, 1947, 3, folder 095 “National Association for the Advancement of Colored People,” box 25, Records of the Department of Health, Education and Welfare, RG 235, NARA II.

156 Walter White to Harry S. Truman, October 21, 1947, 4, Folder 095 “National Association for the Advancement of Colored People,” Box 25, Records of the Department of Health, Education and Welfare, RG 235, NARA II.

157 Beardsley, A History of Neglect, 245-272; Gamble, Making a Place for Ourselves, 182-196. This process could take a while. As late as the early 1960s Chicago still had hospitals that refused black patients, see St. Clair Drake and Horace R. Cayton, Black Metropolis: A Study of Negro Life in a Northern City (New York, NY: Harcourt, Brace and Company, 1945). There were also hospitals that segregated by religion and ethnicity and this practice began to die out during the same period as that of black hospitals, see David Barton Smith, The Power to Heal: Civil Rights, Medicare, and the Struggle to Transform America’s Health Care System (Nashville, TN: Vanderbilt University Press, 2016), 19. 422

In the late 1940s, the efforts of the NMA, NAACP, and other groups promoting

African American interests in health gained some traction in tearing down racial barriers.

In 1946, YMCAs and YWCAs issued a national call for branches to desegregate. The

National Association of Colored Women (NACW) played a critical role here, with many of its members joining the YWCA and demanding that the organization confront its segregationist policies.158 That same year, the American Nursing Association, in stark contrast to the AMA, acknowledged the complaints of Staupers’ NACGN and began accepting qualified black nurses whose state associations refused to allow them to become members.159 With the issue of black membership now a moot point, state nursing associations quickly moved to allow African Americans to join.160 1946 was also the year that the American College of Surgeons ended its restriction on black membership.161

By 1949, Roscoe Brown reported that the American Nursing Association had a black member on its board; the National Tuberculosis Association had African Americans on its staff at both the state and local levels; and all accredited schools of public health offering degrees in health education admitted blacks.162 These changes came on the heels of Truman’s decision to desegregate the army. It is worth noting that all these policies

158 For more on the desegregation of the YWCA, see Bettye Collier-Thomas, Jesus, Jobs, and Justice: African American Women and Religion (New York, NY: Knopf, 2010), 375-383. Desegregation in these organizations was not universal and took a long time to trickle down to local affiliates, see Smith v. Young Men’s Christian Association (1970).

159 “American Nurses Association Admits Negro Nurses,” NNHN 14(3) 1946: 23.

160 “Negro Nurses Admitted to Oklahoma State Association,” NNHN 15(4) 1947: 23; “Negro Nurses in North Carolina Dissolve Their Organization,” NNHN 17(4) 1949: 27.

161 G. Parris, “American College of Surgeons Admits Negro Candidates,” Opportunity, 25(1), January 1947: 29.

162 Roscoe C. Brown, “The Health Education Programs of Government and Voluntary Agencies,” JNE 18(3) Summer, 1949: 377-387, 382-383. 423 and decisions do not necessarily indicate that white Americans became more enlightened or that racism decreased. For example, Truman got significant pressure to end segregationist practices in the government not only from the NAACP, but also from A.

Philip Randolph and his Committee against Jim Crow in Military Service and Training.

Truman needed to get these organizations and their black supporters to come out for his election, and announcing the desegregation of the army was a good way to rally black support.163 Nevertheless, Brown concluded that “There is a definite and encouraging trend toward integration of the Negro in all phases of community, state, and national life.

As this desirable and democratic trend proceeds, the need for separate programs and procedures will recede.”164

Ironically, many learned of desegregation developments reading the National Negro

Health News, a journal targeting a segregated population. It was also a journal published by an organization with a dearth of black employees. Indeed, Walter White noted in his letter to Truman that, “One Negro dentist [Roscoe Brown] for many years has been the chief, and practically sole representative in the field of health for Negroes in the United

States Public Health Service.”165 White condemned the lack of opportunity for blacks within a health organization promoting black health. In addition to White’s attack and the calls for integration from professionals both inside and outside of the health field, a

163 Eric Arnesen, “A. Philip Randolph: Labor and the New Black Politics,” in The Human Tradition in the Civil Rights Movement, ed. Susan M. Glisson (New York, NY: Rowman & Littlefield Publishers, Inc., 2006): 79-96, 89-91.

164 Brown, “The Health Education Programs of Government and Voluntary Agencies,” 387.

165 Walter White to Harry S. Truman, October 21, 1947, 4, folder 095 “National Association for the Advancement of Colored People,” box 25, Records of the Department of Health, Education and Welfare, RG 235, NARA II. 424 growing amount of research showed that poor health was due to environment and income, not race. Thus, a campaign targeting one racial group, and ostensibly overseen by another, was problematic at best, and counter to the trend of the late 1940s.

After World War II, the calls for a renaming or reframing of the “Negro” part of the

Week, which had occurred since the Week’s inception, grew louder. In Philadelphia, where the city’s 1944 campaign set records for participation, the 1946 Week met with a completely different reaction. According to the Philadelphia Tribune, at the close of the

1944 campaign, “it was found that public opinion opposed the designation of health as a racial difference.”166 In response, Philadelphians created a city-wide committee to integrate all races in health work. As the Tribune explained in 1946, “Consequently, no week has been set aside in this city to give special attention to Negro health.”167 Although the Tribune eventually returned to supporting NNHW, it never returned to its outright support as in years past. It acknowledged that the Week could make some African

Americans feel “squeamish” or question the “whys and wherefores” of a week whose name promoted racial difference.168

The City of Brotherly Love was not alone in its consternation about NNHW. In 1946, the Chicago Defender, while promoting NNHW, joined in complaining that, in the words

166 “Nation Has 1 Health Week; Phila. Observes 52 Weeks,” Philadelphia Tribune, March 30, 1946, 20. On the 1944 campaign see “Many Groups Here Observe Health Week,” Philadelphia Tribune, April 8, 1944, 3; “City Officially Sponsors Nat’l Negro Health Week,” Philadelphia Tribune, March 18, 1944, 2; John P. Turner, “National Health Negro Wek – A Radio Broadcast,” JNMA 36(4), July 1944: 118-119.

167 “Nation Has 1 Health Week; Phila. Observes 52 Weeks,” Philadelphia Tribune, March 30, 1946, 20.

168 “Negro Health Week,” Philadelphia Tribune, January 17, 1948, 4; Eustace Gay “Fact and Fancies,” Philadelphia Tribune, March 25, 1950, 4. 425 of Dr. U. G. Daily, “Many of us are becoming more and more impatient with the idea of

‘Negro’ this and ‘Negro’ that, instead of straight programs for all Americans.”169 The following year, the paper celebrated that “many communities and areas sponsor ‘Health

Weeks’ now with no reference to race.”170 Indeed Richmond’s NNHW clinic accepted whites, as did Atlantic City’s NNHW Red Cross classes on basic nursing, and Baltimore played up its Marathon’s interracial nature.171 In Tulsa County, where African Americans created the Tulsa County Negro Health Committee to coordinate health activities, the

Committee voted to let whites become members.172 Thus, when Brown announced the

1950 NNHW theme of “Evaluation,” that is, evaluating the utility of the Week, Eustace

Gay of the Philadelphia Tribune called it “eminently wise.”173

The rebukes from newspapers, combined with the growing demands for integration from the NMA, NAACP, NACW, NACGN and other black organizations, put NNHW in an awkward position. After all, at its core, African Americans still led the Week. Brown, an African American, was Chairman, and the entire NNHW Committee was black. By the 1940s, much of the campaign supported and promoted the work of medical

169 U. G. Daily, “Until the Doctor Comes: National Negro Health Week,” Chicago Defender, March 23, 1946, 15. See also Charley Cherokee, “National Grapevine: To Your Good Health, Suh!” Chicago Defender, March 23, 1946, 14.

170 Alfred Smith, “Adventures in Race Relations,” Chicago Defender, May 10, 1947, 15.

171 “Multitest Clinic to be Located in YM Building,” Baltimore Afro-American, April 8, 1950, 14; “James Briscoe, “Atlantic City News,” Philadelphia Tribune, April 13, 1948, 14; “Morganite Cops Balto. Marathon,” Baltimore Afro-American, April 20, 1946, 14; “Interracial Competitors, Baltimore Maryland, 1946, National Negro Health Week Marathon,” NNHN 14(3) 1946: image, 17.

172 “Tulsa County, Okla., Negro Health Committee Health Week Report,” NNHN, 17(3) 1949: 11.

173 Eustace Gay, “Facts and Fancies,” Philadelphia Tribune, February 21, 1950, 4. 426 professionals, and black medical professionals in particular. The Week boosted their status within the African American community even as they attacked the Week.

Additionally, according to the News, the campaign had a resurgence in popularity in the late 1940s. From 1945-1949, the amount of literature handed out grew more than

1200% and the number of movies and attendance at these films rose 233%. The figures on health exhibits, clinics, and sermons were even more significant. The number of health exhibits increased by 75% from 1945-1949, and the number of clinics remained the same.

However, attendance at the exhibits increased 700%, and at clinics it increased 566%. In this five year span, the average number of people attending a clinic increased from just 86 to 571. Most surprisingly, while the number of sermons made during the Week decreased by 25%, attendance at such sermons increased 200%, meaning that the average sermon in

1949 drew 300 more people (400 total) than it did in 1945.174

The statistics suggested that African Americans had a massive amount of interest in the Week. Indeed, the attendance figures the News reported for the overall numbers of

NNHW participants broke NNHW records. In 1946, attendance had fallen to just over 2.6 million as the country reorganized itself after the war. Yet in 1947, 1948, and 1949, the reported total participation was 9,675,000; 8,650,000; and 9,500,000 respectively. These figures were all the more impressive given the 20% reduction in the number of communities that participated during those years. These were by far the highest numbers

174 “National Negro Health Week Awards, Year 1945,” NNHN 13(3) 1945: 1; “National Negro Health Week Awards, Year 1946,” NNHN 14(3) 1946: 1; “National Negro Health Week Awards, Year 1947,” NNHN 15(3) 1947: 1; “National Negro Health Week Awards, Year 1948,” NNHN 16(3) 1948: 1; “National Negro Health Week Awards, Year 1949,” NNHN 17(3) 1949: 1. 427 for NNHW involvement on record, almost doubling the previous high of 5,400,000 recorded in 1943.175

Interestingly, Brown and the PHS seemed to believe that the figures from 1947-1949 were incorrect. PHS annual reports usually copied the data that the NNHW Committee collected. The reports added up the attendance figures of various NNHW activities to arrive at a total number of participants to demonstrate the utility of the Week in its annual assessment of its work.176 However, the PHS annual reports of 1947 and 1948 estimated only 3 and 3.5 million participants for these years, even though the previous accounting method would have totaled nearly triple this figure.177 The 1949 and 1950 reports omitted a discussion of NNHW entirely. Clearly, there was a discrepancy between the data the

News reported and the actual participation figures.

During World War II, the News had turned to using estimates rather than specific counts for its NNHW data analysis. After the war, this strategy continued, opening the door for inaccuracy in a couple of ways. First, it was in both NNHW’s and the PHS’ best interests to suggest that the Week was popular. High attendance figures for NNHW would encourage the PHS to continue to fund the campaign. A large number of

175 “National Negro Health Week Awards, Year 1945,” NNHN 13(3) 1945: 1; “National Negro Health Week Awards, Year 1946,” NNHN 14(3) 1946: 1; “National Negro Health Week Awards, Year 1947,” NNHN 15(3) 1947: 1; “National Negro Health Week Awards, Year 1948,” NNHN 16(3) 1948: 1; “National Negro Health Week Awards, Year 1949,” NNHN 17(3) 1949: 1.

176 See for example: Annual Report of the Surgeon General of the Public Health Service of the United States: for the Fiscal year 1938 (Washington, D.C., Government Printing Office, 1938), 106; Annual Reports of the United States Public Health Service: for the Fiscal Years 1941- 1942, 1942-1943 (Washington, D.C., Government Printing Office, 1943), 26.

177 Annual Report of the Federal Security Agency, Section three, United States Public Health Service: for the Fiscal Year 1947 (Washington, D.C., U.S. Government Printing Office, N/D), 430; Annual Report of the Federal security Agency, 1948: Public Health Service (Washington, D.C., U.S. Government Printing Office, 1949), 386. 428 participants would also demonstrate the importance and success of the PHS’ work and encourage Congress to grant it greater funding. Second, those reporting data on the Week had an incentive to aim high when estimating attendance because more participation would make their work look more significant.

It seems almost impossible that participation in clinics would increase so much given there was no change in the number of clinics or an emphasis on clinic use during these years. A similar concern exists for the data on the attendance at health exhibits and sermons, events where there was often no method of documenting exact attendance. Even within the Week’s data estimates there were some signs that the figures did not add up.

The Week’s participation across the country decreased from 45 to 35 states during this period. The numbers of homes and lots, planting projects, and newspaper articles also decreased. This last data point is especially noteworthy since it seems axiomatic that a campaign that attracted 9 million people should receive more press coverage than one that attracted only 2.6 million.178 Lastly, it seems highly unlikely the PHS would need to take a year to evaluate whether to continue a campaign that attracted as many as two out of every three African Americans.179

Yet that was what it did in 1950 when it introduced the theme “Evaluation

Anniversary of the National Negro Health Week Program” for the 36th year of NNHW.

Such a theme appeared to recognize the growing animosity towards racial separation in

178 “National Negro Health Week Awards, Year 1945,” NNHN 13(3) 1945: 1; “National Negro Health Week Awards, Year 1946,” NNHN 14(3) 1946: 1; “National Negro Health Week Awards, Year 1949,” NNHN 17(3) 1949: 1.

179 The African American population in 1950 was 15,042,286. See U.S. Bureau of the Census, Statistical Abstract of the United States, 1955 (Washington, D.C.: U.S. Department of Commerce, 1955), 33. 429 health, the negative optics surrounding the Week, and concerns about attendance and participation. Indeed, the theme prompted the Philadelphia Tribune’s Gay to wonder if

“Negro Health Week may have served its purpose.”180 After all, while Roscoe Brown led the Week, he was still a member of the NMA. Running the Week, with its questionable public support and in the face of the NAACP’s and NMA’s fight for integration in health care represented, at best, an inconsistent position on African American health.

Further up the chain of command, the Week faced challenges as well. In 1939, the government placed the U.S. Public Health Service under the purview of the Federal

Security Agency (FSA). This reorganization had little, if any, effect on the Week during

World War II. If anything, the Week served FSA purposes as health patriotism became an important part of the war campaign. After the war, NNHW continued to receive funding and advocacy from Surgeon General Parran and other government officials. However,

Parran, who had provided Brown with the resources and financing to help him grow the

Week, retired in 1948. His replacement, Leonard A. Scheele, had not worked closely with the Week and had different interests in health than his predecessor.

Instead of Parran’s focus on syphilis and other infectious diseases, which tied into preconceived notions about African American health issues, Scheele concerned himself with raising money for medical research on chronic diseases. Heart disease and other chronic conditions were not contagious and not tied to ideas about African American ill health like infectious diseases were. This focus on chronic illnesses made the Week’s priorities less relevant to Scheele.181

180 Eustace Gay, “Facts and Fancies,” Philadelphia Tribune, February 21, 1950, 4.

430

In 1947, the FSA had also changed administrators, putting Oscar Ewing in charge.

Ewing was a progressive on civil rights and health. As Cobb put it, through Ewing’s

“signal efforts,” he opened Washington, D.C.’s Gallinger Hospital (it was renamed D. C.

General in 1953, and closed in 2001), which served mostly poor blacks and was open to

African American physicians.182 Ewing expanded black employment opportunities in the

FSA and encouraged the PHS to enforce the non-discrimination provisions of Hill-

Burton.183 For Ewing, the Week’s anti-integration name was at odds with his work.

Both Ewing and Scheele recognized the issues in health that blacks faced, but they were not as invested in the success of the Week as their predecessors.184 As Surgeon

General, Scheele touted a progressive vision, “The Public Health Service believes that the process of integration is the way to future health progress.”185 A week dedicated solely to

African American health appeared antithetical to Scheele’s directive. Similarly, Ewing closed his 1948 interview promoting NNHW by stating “Our [the FSA’s] goal is to see that all the people of this Nation have a greater opportunity to lead healthier lives.”186

181 Angela Castellanos, “Federal Government and African-American Communities Identifying and Defining African-American Health Disparities Through Intervention: The National Negro Health Week Movement and Office of Negro Health Work From 1915–1951,” doctoral dissertation, Harvard Medical School, Cambridge, MA, 2015, 32, 40; Bess Furman, “181 Centers Push Fight on Cancer,” New York Times, November 24, 1947, 25.

182 W. Montague Cobb, “Progress and Portents for the Negro in Medicine,” The Crisis April 1948: 107-122, 107.

183 J. Y. Smith, “Oscar Ewing Dies,” The Washington Post, January 9, 1980, C6; Thomas, “The Hill-Burton Act and Civil Rights,” 849-852.

184 “All U.S. Effected By Problems of Health Standards,” Philadelphia Tribune, April 3, 1948, 13; “The National Health Problem,” NNHN 16(1) 1948: 1-2; Leonard A. Scheele, “Negro Health Week and the Health of the Negro,” NNHN 17(3) 1949: 5-6.

185 Leonard A. Scheele, “The Health Status and health Education of Negroes – A General Introductory Statement,” JNE 18(3) Summer, 1949: 200-208, 207.

431

Even as he trumpeted the cause of NNHW, Ewing recognized how interconnected health was to both races, and that the FSA needed to improve health outcomes for all. Such a statement appears somewhat out of place for a National Negro Health Week, but not for a

National Health Week, and it illustrated the influence of Cobb, the NMA, and the

NAACP.

End of the Line

By 1950, the modern Civil Rights Movement had begun. The Movement coincided with the abrupt end of both the News and Week. The News’ first issue of 1950 contained no hint that the second issue of that year would be its last. Similarly, nowhere in the second issue mourning the end of the News did Brown state that the Week and Movement would end. While readers might have surmised the end was nigh, Brown’s silence on this topic suggests that he at least believed the campaign might continue.

Formal recognition of the end of the Week did not come until February of 1951. The official press release noted the length of the campaign, its origins in Booker T.

Washington’s work, and the efforts of Roscoe Brown and the PHS. Notably, FSA

Administrator Oscar Ewing, not Brown, issued the press release and provided the reasoning for the campaign’s demise. It was “in keeping with the trend toward integration of all programs for the advancement of the people in the fundamentals of health, education, and welfare.” To that end, the release explained that the Office of Negro

Health Work would be renamed the Special Program Branch, but would continue its

186 “The National Health Problem,” NNHN 16(1) 1948: 1-2, 2. 432 work as a “clearing house” of health information with Brown still in charge.187 That a white man issued the statement ending a program for, and largely run by, African

Americans was noteworthy only in its keeping within the pattern of white oversight of black bodies, and went unremarked upon. Indeed, it illustrates the historian David Barton

Smith’s contention that, “By 1950 white physicians and their medical associations had achieved total professional dominance over the American health system.”188

The trend that Ewing noted had become particularly high profile by 1951. The year before, and for the very first time, AMA physicians elected an African American to the group’s House of Delegates.189 For an organization that continued to permit its member associations to practice racial discrimination, such an event was significant; but the developments in the nursing field were even more striking. When the American Nursing

Association (ANA) removed its racial barriers from membership in 1946, the NACGN welcomed the decision, but remained active as it continued to advocate for black nurses.

However, in January of 1951, the African American group did, in the words of historian

Darlene Clark Hine, what “no other black professional or protest organization had ever done.”190 Deciding that the profession had reached the degree of integration that made

187 “Separate Health Week Movement Ends Officially,” Baltimore Afro-American, February 24, 1951, 12; “Nat. Negro Health Wk. Abandoned as Separate Venture,” Philadelphia Tribune, February 17, 1951, 16; “Scrap National Negro Health Week,” Chicago Defender, February 24, 1951, 2; “National Negro Health Program Ends,” JNMA, 43(3), May, 1951: 198-199.

188 Smith, The Power to Heal, 21. See also Paul Starr, The Social Transformation of American Medicine (New York, NY: Basic Books, 1982), 311-334.

189 “American Medical Association Elects First Negro to House of Delegates,” NNHN 18(1) 1950: 27.

190 Hine, Black Women in White, x. 433 having a separate organization based on race unnecessary, it voted to dissolve the

NACGN and merge with the ANA.

Perhaps there was little reaction to Ewing’s announcement due to the conglomeration of these events, that is: African American advocacy for integration in health; the beginning of the trend toward removing racial barriers; Truman gradually integrating the

Army and being the first president to speak before the NAACP; the Supreme Court’s abolition of “racial covenants” in housing; and decreased participation in the Week. The

Chicago Defender, Baltimore Afro-American and the Philadelphia Tribune did not publish any op-eds or eulogies about the Week. These papers printed the FSA’s press release from Ewing, and then let the Week fall from public memory.191

Surprisingly, the group that gave the most coverage to the Week’s demise was the

NMA, an organization that had struggled with its role in the Week. Under Cobb’s guidance as editor, the JNMA celebrated Ewing’s decision. The JNMA asserted that

Ewing made his decision “because it was time that Negro health ceased to be considered as a special and separate kind of health, apart from that of the general population.”192

Cobb portrayed this decision as part of a pattern of increased efforts in integration throughout the medical profession, noting that in addition to the dissolution of the

191 “Scrap National Negro Health Week,” Chicago Defender, February 24, 1951, 2; “Separate Health Week Movement Ends Officially,” Baltimore Afro-American, February 24, 1951, 12; “Nat. Negro Health Wk. Abandoned as Separate Venture,” Philadelphia Tribune, February 17, 1951, 16.

192 “The Honorable Oscar Ross Ewing,” JNMA, 43(6) November, 1951: 402-404, 403. 434

NACGN and NNHW, a variety of state and local medical associations had eliminated their racial qualifications for membership.193

However, in eliminating the Week, African Americans lost a campaign that many perceived as promoting racial uplift. The Week helped white authorities realize the role that segregation, discrimination, and racism played in poor black health, and connected health with economic and social opportunities for blacks. Both the Philadelphia Tribune and Chicago Defender cited “health authorities” who asserted that “the removal of many present bans in the economic pattern would enable the Negro citizen to afford the necessary medical care, diet, or environmental circumstance that he might not otherwise be afforded.”194 Dr. Dennis Bethea connected the Week with the work of the President’s

Committee on Civil Rights, which proposed “enactment by States of fair health statutes forbidding discrimination and segregation based on race, creed, color, or national origin, in operation of public and private health facilities.”195 From this perspective, the Week was part of the larger Civil Rights fight that was just beginning. Health was not just an element of this battle; for some, it was at the core of the rights African Americans would come to demand for themselves. Without proper health, blacks would not be able to take advantage of the ending of job, housing, and other types of discrimination, or even wielding the vote. Such arguments sounded remarkably similar to those Du Bois had

193 W. Montague Cobb, “The Future of Negro Medical Organizations,” JNMA, 43(5) September, 1951: 323-328.

194 “Better Jobs Mean Better Race Health,” Philadelphia Tribune, March 20, 1948, 9; “Job Bias Injures Negro Health Standards,” Chicago Defender, March 27, 1948, 14. See also “Let’s Close the Gap,” Chicago Defender, April 8, 1950, 6.

195 Dennis A. Bethea, “Why a Health Week?” Baltimore Afro-American, April 10, 1948, M13. 435 made a half century earlier and which had been part of the impetus for creating the Week in the first place.

Within the confines of health, the end of the Week also had important overtones. As the historian David McBride puts it, “Ironically, this [the folding of the Week into the

Special Programs Branch and the NACGN disbanding into the ANA] meant that those black institutions traditionally most effective in stimulating community health projects throughout the nation’s black population were merged into larger, predominately white- controlled organizations.”196 The black voice in medicine, such as it was, shrunk significantly in 1950-1951. Without the NNHWM and the NACGN, the NMA became the largest and most vocal black health institution. Notably, it was an institution that had the least trust among African Americans. Without the NACGN and the Week, it was now up to the few black, and many white, medical professionals to improve racial equality in health care, for better or for worse.

196 McBride, From TB to AIDS, 145. 436

CHAPTER 7

CONCLUSION

Over the course of NNHW’s 35 years, the death rates for African Americans and other people of color decreased from 20.2/1,000 to 11.2/1,000 and the average life expectancy increased from 38.9 years to 60.8.1 Similarly, their rates of fetal death, neonatal mortality, infant mortality, and maternal mortality all declined significantly during this period as well.2 The African American population not only did not die out as

Hoffman had predicted, but it grew from just under 9 million in 1910 to just over 15 million by 1950.3 Although in announcing NNHW, Washington had said “Without health and long life all else fails,” these statistics do not indicate NNHW’s success and the

Week should not receive credit for them.4 These changes were due to the massive expansion and improvement in public health, sanitation and municipal services, and scientific and medical advances that occurred during this period and which became more accessible to African Americans.

1 U.S Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970 (Washington, D.C.: U.S. Department of Commerce, 1975), 59, 55. Note that these figures are for “Negro and other.”

2 U.S Bureau of the Census, Historical Statistics of the United States, Colonial Times to 1970 (Washington, D.C.: U.S. Department of Commerce, 1975), 57. Note that these figures are for “Negro and other.”

3 U.S Bureau of the Census, Statistical Abstract of the United States, 1920 (Washington, D.C.: U.S. Department of Commerce, 1921), 40; U.S Bureau of the Census, Statistical Abstract of the United States, 1954 (Washington, D.C.: U.S. Department of Commerce, 1954), 37.

4 Booker T. Washington, Gallery Proof, January 15, 1915, 827, “National Negro Health Week,” reel 713, BTW, TA. Among other newspapers, this Gallery Proof was published verbatim in The Chicago Defender and the Baltimore Afro-American on January 23, 1915. It ran in the Philadelphia Tribune on February 13, 1915. 437

However, at a basic level, the Week was successful in that it taught African

Americans about hygiene and public health principles, its original goal.5 Compared to the health pamphlets physicians wrote, the Week’s leaders used more common language to explain health practices. In addition to the specific tips about making privies clean and when to wash hands, the Week’s leaders cooperated with many organizations to make this information as accessible as possible, and millions received these lessons.

On the other hand, the Week had less success in creating structural changes for

African Americans to take control of their own health. The most direct way to improve

African American health would have been to advocate for the desegregation of medical schools, hospitals, clinics, and municipal services. While the hygiene tips the Week espoused and community organizing it supported were useful and made a contribution to the increase in African American health, blacks still needed to see medical professionals.

Although local weeks did occasionally organize to promote greater equality, nationally the Week did little to advocate for more black physicians and nurses.6 Its calls for blacks to use more of the health services available did not recognize the racial discrimination that many medical professionals practiced which left many blacks with little access to

5 Vanessa Gamble and Deborah Stone characterize the goals of the Negro Organization Society of Virginia’s health week in 1913 as “to teach African Americans about the principles of public health and hygiene to help them become stronger and more effective citizens.” Since Washington based much of NHW on Moton’s work and used a number of the Society’s publications in promoting what became NNHW, the goals of the Society’s Week seem a reasonable standard to judge NNHW by. See Vanessa Gamble and Deborah Stone “U.S. Policy on Health Inequities: The Interplay of Politics and research,” Journal of Health Politics Policy and Law 31 (1), February 2006: 93-126, 101.

6 Although the figures varied year-to-year, the number of black doctors increased by just 200 between 1920 (3,495) and 1950 (3,660). See U.S Bureau of the Census, Statistical Abstract of the United States, 1925 (Washington, D.C.: U.S. Department of Commerce, 1926), 40; U.S. Bureau of the Census, 1950 United States Census of Population: Employment and Personal Characteristics (Washington, D.C.: U.S. Department of Commerce, 1953), 1B-29. 438 medical care. Indeed, at the national level, the Week never called out racism explicitly or demanded that African Americans have equal access to health services as whites.

Washington and Moton both advocated accommodation and, under the USPHS, Brown took a similar position. They all encouraged interracial cooperation and white support while stopping short of suggesting blacks have an equal share in health care.

For Washington and Moton, taking such a position would have risked the cache of support they had among white philanthropists who gave to Tuskegee. Both leaders advocated black people accept their place in society and not challenge the status quo.7 As the PHS’ only black employee, Brown may have been wary of directly challenging the practices of his white medical colleagues. During the 1930s the News’ articles promoting equal access to health care and more hiring of black physicians often failed to call out the racist practices that made such calls necessary.8 However, as an NMA member, his editorial choices tended to reflect the ideas of the NMA. As the group moved its support from equal access to racial equality, so did the News.9

The story of National Negro Health Week illustrates historian Suellen Hoy’s assertion that cleanliness (and we, like Washington, might include health as well) was “something

7 Louis Harlan, Booker T. Washington: Volume 2: The Wizard of Tuskegee, 1901-1915 (New York, NY: Oxford University Press, 1983), see 128-142 for Washington’s connections to white philanthropists.

8 See for example: Taliaferro Clark, “The Negro Tuberculosis Problem,” National Negro Health News (NNHN) 1(2) 1933: 17-18; “Suggested Remedies for Solution of Health Problems of Negroes,” NNHN 4(1) 1936: 5-7; Elizabeth C. Tandy, “Infrant and Maternal Mortality Among Negores,” NNHN 7(2) 1939: 19-21; Walter J. Hughes, “The Particular Needs of Negores,” NNHN 7(4) 1939: 17-20.

9 See for example: Paul B. Cornely “Negro Health Problems Can Be Solved,” NNHN 13(2) 1945: 7; “American Nurses Association Admits Negro Nurses,” NNHN 14(3) 1946: 23; “The National Health Problem,” NNHN 16(1) 1948: 1-2; “Study of Negro Health Status Reveals Progress, But Much More Improvement Needed,” NNHN 18(1) 1950: 18-19. 439 more than a way to prevent epidemics and make cities livable – it became a route to citizenship, to becoming American.”10 NNHW supported and promoted Victorian health practices as a way to improve black health, since geography and racism left blacks with few other options to combat disease. Implementing these practices, such as whitewashing and painting, had an ancillary benefit in that it demonstrated the utility of educating blacks about health, and fought against racist ideas about inherent black ill health and uncivilized behavior. In this way, the Week challenged some of the reasons whites gave for the second-class status of African Americans in society.

As black communities worked to improve their health, the Week served as a community organizing tool. The Week connected health with the environment, home construction, employment, and access to medical professionals. The campaign encouraged African Americans to assess the health of their community each year and to target a particular health concern to combat. In carrying out NNHW, local leaders publicized the inequality in municipal services that created unhealthy environments in

African American neighborhoods and the poor conditions of the buildings and alleys blacks rented from white landlords. The Week also revealed how geography, poverty and limited black employment options could restrict their access to medical professionals and leaders began to take steps to pool community resources to combat these issues.11

10 Suellen Hoy, Chasing Dirt: The American Pursuit of Cleanliness (New York, NY: Oxford University Press, 1995), 87.

11 See for example Algernon Jackson, “Make Every Week a Real Health Week,” Philadelphia Tribune, April 2, 1927, 15; Algernon Jackson, “National Negro Health Week to be Observed First Week in April,” Savannah Journal, March 26, 1927, “THC, 1927,” 410, TA; “Health Week,” Chicago Defender, April 7, 1928, A2; “Negro Health Week Program at Dunbar High School,” Mineral Wells Index, April 6, 1928, “THC, 1928,” 381, TA; “Urban League to Study ‘Lung 440

The Week’s broad scope led it to partner with a variety of black and white groups.

This interracial work not only fought racism, but also helped to spur the expansion of local government services to blacks. Again, NNHW work was conservative in nature.

While the campaign noted health issues that concerned blacks, it rarely openly challenged racist institutions that helped create such problems. Instead, it publicized health concerns and made pleas and overtures to white health leaders, such as the PHS, to support black health. As the NAACP increased its efforts in the courts to fight racial segregation in the late 1940s, it took the health problems the NNHW campaign had publicized for years and used them to demand equal access to public hospitals and health services.12 Such access became linked with the larger issue of civil rights and citizenship.

Connections between issues of citizenship and health remain today. Scholars Michael

Byrd and Linda Clayton argue that there is a “General assumption and projection that poor health status and outcomes for Blacks and the poor are ‘normal’ and acceptable.”13

Such conclusions reinforce the concept that, as the historian Keith Wailoo puts it,

“disease thought is inextricably bound to social thought and social relations.”14 Agreeing with and expanding on Wailoo, the historian David Rosner asserts that diseases associated not only with race, but also with poverty and homelessness, such as AIDS, are

Block’” Baltimore Afro-American, March 7, 1925, 10; T. W. Josey, “National Negro Insurance Association Health Program,” NNHN 10(3) 1942: 28.

12 Patricia Sullivan, Lift Every Voice: The NAACP and the Making of the Civil Rights Movement (New York, NY: New Press, 2009), 19. This is an excellent reference for the work of the NAACP from its inception through the 1950s.

13 Michael Byrd and Linda Clayton, An American Health Dilemma: The Medical History of African Americans and the Problem of Race, vol. 1, Beginnings to 1900 (Routledge, NY: 2000), xxiv.

14 Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore, MD: The Johns Hopkins University Press, 1997), 200. 441

“social creations and therefore can be addressed through social decisions.”15 People are more likely to stigmatize as unhealthy those living outside of societal norms. While finding cures for diseases are useful, changing the way people think of health and sickness will have a larger effect in altering preconceived notions and decreasing the chances of creating social outcasts.

In this context, the data on African American ill health is instructive in assessing the degree to which African Americans remain outcasts in terms of health. In the year 2000,

Byrd and Clayton estimated that blacks had 90,000 “excess deaths.” Furthermore, they argued that 80% of these deaths were due to treatable health conditions or preventable diseases, problems that went unsolved due to a lack of income or insurance that created barriers for treatment.16 Although African American mortality rates continue to decline, and black life expectancy has increased, the figures for African Americans still lag behind those of whites. In 2016, black life expectancy was 75.5 years, whereas that of whites was 79.17 A greater difference exists in the black infant mortality rate, which in

2018 was 11.3/1,000, as opposed to the 4.9/1,000 for whites. Neither income nor education explains this difference. As Linda Villarosa of New York Times Magazine

15 David Rosner, ed. Hives of Sickness: Public Health and Epidemics in New York City (New Brunswick, NJ: Rutgers University Press, 1995), 16.

16 Byrd and Clayton, An American Health Dilemma, 17. By excess deaths, they mean “the number of deaths due to a particular condition above the level that would have occurred if blacks had experienced the same age-, sex-, and cause-specific mortality rates as whites.” These figures are hard to determine and corroborate and other scholars have found lower tallies using slightly different criteria. See for example James Schafer, The Business of Private Medical Practice: Doctors, Specialization and Urban Change in Philadelphia, 1900-1940 (New Brunswick, NJ: Rutgers University Press, 2014), 2.

17 National Center for Health Statistics, Health, United States, 2016: With Chartbook on Long-term Trends in Health (Hyattsville, MD: U.S. Government Printing Office, 2017), 44. 442 reports, “a black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education.”18

Such anecdotes and data raise questions about racism in health treatment of all classes of African Americans. Doctors continue to treat patients differently based on race.

Controlling for all other factors, such as income and education, people of color are less likely than whites to receive proper medications for heart disease, undergo coronary bypass surgery, or receive kidney dialysis and transplants. However, blacks are 3.6 times more likely than whites to have legs and feet amputated due to diabetes complications.19

Even when treating something as simple as pain, the overwhelmingly white medical establishment deals with the races differently. A 2016 study revealed that much of this discrepancy comes from false beliefs about biological differences between the races that still reside in the medical community, such as that blacks have thicker skin or less- sensitive nerve endings than whites.20 Racist attitudes such as these as well as mistreatment sow distrust of the medical community and medical practices. While the number of black physicians has increased to 45,534, they make up just 5% of all doctors, not nearly enough to combat the impact of these poor medical practices.21

18 Linda Villarosa, “The Hidden Toll,” New York Times Magazine, April 15, 2018: 30-39, 47-48, 51; 33.

19 Brian D. Smedley, Adrieen Y. Stith, and Alan R. Nelson, eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington, D.C.: The National Academies Press, 2003).

20 Kelly M. Hoffman, Sophie Trawalter, Jordan R. Axt, and M. Norman Liver, “Racial Bias in pain Assessment and Treatment Recommendations, and False Beliefs About Biological Differences Between Blacks and Whites,” Proceedings of the National Academy of Sciences of the United States of America, vol. 113, no. 16, April 19, 2016: 4296-4301.

21 “Diversity in Medicine: Facts and Figures 2019,” aamc.org 1 July 1029, 443

The lack of medical insurance exacerbates the inequalities that African Americans and other people of color continue to confront in medical care and treatment. Even with the Affordable Care Act, more than 27 million Americans still do not have health insurance, and African Americans remain underinsured compared to whites.22 If the recent efforts to overturn the Affordable Care Act succeed, the ranks of the uninsured will swell by 23 million immediately and to more than 59 million by 2026.23 How are these people to maintain their health?

According to scholars Sandra Crouse Quinn and Stephen B. Thomas, NNHW provides the answer for how to tackle health problems stemming from a wide range of factors in a population without regular access to health care. They explain that NNHW’s

“combination of governmental support, collaboration among a multitude of organizations, and freedom to develop a campaign appropriate to individual communities suggests a model for community based public health campaigns today.”24

< https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active- physicians-race/ethnicity-2018> (20 February 2020).

22 Dan Mangan, “Obamacare pushes nation’s health uninsured rate to record low 8.6%,” cnbc.com 7 September 2016, < http://www.cnbc.com/2016/09/07/obamacare-pushes-nations- health-uninsured-rate-to-record-low.html> (7 November, 2016); The Commonwealth Fund, March, 2015, 2; National Center for Health Statistics, Summary Health Statistics Tables for the U.S. Population: National Health Interview Survey, 2016 (Washington, D.C.: Government Printing Office, 2016), 1.

23 Madison Park, “Here’s how many would be uninsured in each health care scenario,” cnn.com 18 July 2017, (26 July, 2018); Sheryl Gay Stolber, “Trump Administration Asks Supreme Court to Strike Down Affordable Care Act,” nytimes.com 26 June 2020, (26 June 2020); Meagan Flynn and Tim Elfrink, “Trump administration asks Supreme Court to strike down Obamacare,” washingtonpost.com 26 June 2020, (26 June 2020).

444

National Public Health Week (NPHW), which President William J. Clinton officially designated in 1995, is the first modern attempt to utilize NNHW’s strategies.25 The

American Public Health Association designed NPHW to address the health problems of all types of people: low income whites, Native Americans, Hispanic and Asian

Americans, even seniors. As per Quinn and Thomas’ recommendation, the Association allows communities to modify the campaign to fit their area’s particular needs, and cooperates with hundreds of groups.26

Its content is also similar to that of NNHW. It addresses individual actions and practices that people can implement to improve their health without physicians, such as

“eating healthy, avoiding tobacco, receiving vaccinations, and using seatbelts.”27 Part of the goal is to empower people to advocate and improve their health on their own. NPHW also connects health problems, particularly those in working class and poor neighborhoods, to greater issues of inequality. As New Mexico U.S. Senator Tom Udall put it in promoting NPHW, “We know that food contributes to a longer life. But it is difficult to choose a healthy diet if you live in a community without access to a store that

24 Sandra Crouse Quinn and Stephen B. Thomas, “The National Negro Health Week, 1915 to 1951: A Descriptive Account,” Minority Health Today 2(3) March/April 2001: 44-49, 48. This is a reprint from the Journal of Wellness Perspectives (now the American Journal of Health Studies 12(4) 1996: 172-179.

25 Starting with this paragraph and ending with the paragraph starting “In 2020,”) the material here is taken directly from an article written by the author. See Paul Braff, “Moving from the National Negro Health Week to the National Public Health Week in America,” American Journal of Public Health (AJPH) 110(4) 2020: 470-477.

26 Interview with Dr. Georges Benjamin, American Public Health Association Executive Director, by Paul Braff, via Zoom oral interview, October 1 2019, 4:00 p.m. - 5:00 p.m.

27 Mary E. Northridge, “We are the 99 Percent,” AJPH 102(4) 2012: 585; Georges C. Benjamin, “Safety Is No Accident: Live Injury-Free,” AJPH 101(4) 2011: 586. See also Tom Udall, “National Public Health Week: Small Steps Toward Big Change,” AJPH 106(5) 2016: 779-780; Sandro Galea and Roger D. Vaughan, “Public Health and Marginalized Populations: A Public Health of Consequence, October 2019,” AJPH 109(10) 2019: 1327-1328. 445 sells affordable, fresh produce.”28 NPHW highlights the roles that poverty, housing, education, the environment, and even transportation have in affecting health and implementing best practices.29

The major problem that challenges NPHW is the same one that Booker T.

Washington faced when he started Negro Health Week in Tuskegee, Alabama over a century ago. As Udall explained, “We often think of good health as something that happens in a doctor’s office. The unfortunate reality, however, is that even the best medical care in the world will not solve some of our nation’s most pressing health problems.”30 Simply put, there are too few medical professionals, and too many socioeconomic issues tied to health for medical professionals to solve. As NNHW demonstrated, Americans need nonmedical professionals to help bridge the gap, to advocate for health in ways that medical professionals cannot.

In 2020, America is an extremely divided nation, beset by white supremacy and, at this writing, faced with a global pandemic decimating the population. As of June 2020 the Coronavirus has claimed more than 120,000 American lives. Of that number, for each

100,000 Americans (of their respective groups), 65.8 blacks have died, along with about

31.1 Latinos and 28.5 Whites. These rates are so disparate it can be hard to appreciate what this means. To put it plainly: “If [Black Americans] had died of COVID-19 at the

28 Tom Udall, “National Public Health Week: Small Steps Toward Big Change,” AJPH, 106(5) 2016: 779-780, 779.

29 Caroline D. Bergeron, “Envisioning a Healthier Future,” AJPH, 105(4) 2015: 612. See also Galea and Vaughan, “Public Health and Marginalized Populations,”; Naomi Zevde, Erica Eliason, Heidi Allen, Tal Gross, “The Effects of the ACA Medicaid Expansion on Nationwide Home Evictions and Eviction-Court Initiations: United States, 2000-2016,” AJPH 109(10) 2019: 1379-1383.

30 Udall, “National Public Health Week,” 780. 446 same rate as White Americans, at least 15,000 Black Americans…would still be alive.”31

While we have an incomplete picture of the toll of COVID-19, the existing data reveals deep inequities by race, especially for black Americans.

Improving health for the neediest populations is not only humane, but will also improve the nation’s overall health. Without universal health care, we need more campaigns like NPHW and NNHW that empower people to work together for the betterment of all. As Washington said, “We may differ on other subjects, but there is no room for difference here. Let us make a strong, long united pull together.”32

Similar to many other black leaders, Washington continued to hope for change.

However, the reality is that throughout American history, “the hallmarks of American democracy – opportunity, freedom, and prosperity – have been largely reserved for white people through the intentional exclusion and oppression of people of color. The deep racial and ethnic inequities that exist today are a direct result of structural racism: the historical and contemporary policies, practices, and norms that create and maintain white supremacy.”33 Politicians attempting to combat such inequality have turned to police policies, government subsidies, and legislation. The study of NNHW suggests that a focus on healthcare could generate the most cross-racial appeal and interest in beginning the long, arduous, and absolutely vital process of tackling structural racial inequality.

31 American Public Media Research Lab Staff, “The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S.,” apmresearchlab.org 24 June 2020, (25 June, 2020).

32 Booker T. Washington, Gallery Proof, January 15, 1915, 827, “National Negro Health Week,” reel 713, BTW, TA.

33 The Urban Institute, “Structural Racism in America," www.urban.org, (25 June, 2020). 447

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