THE CITY THAT CARE FORGOT: APARTHEID HEALTH CARE, RACIAL HEALTH DISPARITY, AND BLACK HEALTH ACTIVISM IN NEW ORLEANS, 1718-2018 A Dissertation submitted to the Faculty of the Graduate School of Arts and Sciences of Georgetown University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in History By Kevin George McQueeney, M.A. Washington, DC June 16, 2020 Copyright 2020 by Kevin George McQueeney All Rights Reserved ii THE CITY THAT CARE FORGOT: APARTHEID HEALTH CARE, RACIAL HEALTH DISPARITY, AND BLACK HEALTH ACTIVISM IN NEW ORLEANS, 1718-2018 Kevin McQueeney, M.A. Thesis Advisor: Marcia Chatelian, Ph.D. ABSTRACT This work examines the apartheid health care system in New Orleans from the city's founding in 1718 through the present, addressing several research questions. What factors led to the development and perpetuation of the apartheid health care system in New Orleans? What are the connections between apartheid health care and the larger system of racist hierarchy? How has apartheid health care impacted the health of Black residents? How have Black New Orleanians fought against this system and for improved health? This work main's arguments can be summarized as follows. First, apartheid health care emerged as a key component of the slave-based economy, became institutionalized with the end of Reconstruction and the rise of Jim Crow, and helped support the system of segregation in the Crescent City; sadly, an apartheid health care system still exists today. Second, the medical system served white interests in ways that financially benefitted members of the medical community and both accommodated and supported the prevailing economic system and racist hierarchy from slavery, to Jim Crow, to the post WW-II liberal order of de jure segregation, and into the post-Katrina world of ascendant liberalism. Third, government policies at the local, state, and federal level helped the apartheid health care system grow and sustain. Fourth, within these shifting institutional and power structures, Black New Orleanians fought for access to health care iii and improved health, including carving out their own health care system, but always had to confront the limits imposed by the racist hierarchy. Ultimately, this work posits that the apartheid health care system's survival was not inevitable. Although many factors facilitated its rise and perpetuation, there were crucial turning points when the apartheid health care system could have ended. These moments occurred in the late 1860s and 70s, the late 1960s and70s, and post-Katrina, when opportunities existed to dismantle, not expand, the apartheid health care system in New Orleans. These opportunities evaporated, but only because individual actors chose to maintain the apartheid health care system. iv TABLE OF CONTENTS INTRODUCTION ...............................................................................................................1 Introduction ......................................................................................................................1 Argument .........................................................................................................................7 Literature Review ...........................................................................................................12 Breakdown of Chapters ..................................................................................................30 CHAPTER 1: HEALTH AND HEALTH CARE IN THE ERA OF SLAVERY, 1718- 1843....................................................................................................................................36 Introduction ...................................................................................................................36 Origins of Apartheid Health Care ..................................................................................39 Americanization .............................................................................................................45 Medicine and Slavery: The Ideologues ..........................................................................46 The Health of and Health Care for Enslaved People .....................................................50 CHAPTER 2: THE GROWTH OF THE SLAVE-BASED HEALTH CARE ECONOMY, 1800-1861 ..........................................................................................................................61 Introduction ...................................................................................................................61 Private Hospitals and Slavery ........................................................................................62 Charity Hospital and Slavery .........................................................................................67 Medical Schools and the "Medical Metropolis of the South" ........................................73 Black Health Care ..........................................................................................................85 CHAPTER 3 THE CIVIL WAR, RECPONSTRUCTION, AND THE RISE OF JIM CROW HEALTH CARE, 1862-1900 ................................................................................92 Introduction ...................................................................................................................92 v Health Care in Crisis and the Freedmen's Hospital .......................................................93 Charity Hospital Under Occupation .............................................................................108 The Postwar Health Care System ................................................................................112 Black Medical Schools and Physicians ........................................................................117 Rise of the Redeemers and the Institutionalization of Jim Crow Health Care ........... 124 Flint Medical College and Flint Goodridge Hospital .................................................130 CHAPTER 4: A WHITE MEDICAL DISTRICT, 1900-1940 ........................................135 Introduction ..................................................................................................................135 A Growing Health Care Economy and Public Health .................................................140 A White Medical District .............................................................................................147 New Orleans as a Medical "Center" ............................................................................158 CHAPTER 5: JIM CROW BLACK HEALTH CARE, 1927-1950 ................................166 Introduction ..................................................................................................................166 Creating a Black Medical District ................................................................................168 Flint Goodridge's Many Initial Challenges ..................................................................176 A Black Health Center .................................................................................................183 "Slum" Clearance in Central City ................................................................................191 World War II and Postwar Problems ...........................................................................195 CHAPTER 6: HEALTH CARE IN THE ERA OF CIVIL RIGHTS AND RESISTANCE, 1960-1968 ........................................................................................................................203 Introduction ..................................................................................................................203 Flint Goodridge Hospital and Health Care Desegregation ..........................................204 Civil Rights and Health Care .......................................................................................214 vi Integration at Charity ...................................................................................................225 Private Hospitals Defy Integration ...............................................................................233 White Flight Hospitals .................................................................................................236 CHAPTER 7: TWO-TIERED HEALTH CARE, 1965-1974 ..........................................247 Introduction ..................................................................................................................247 A Modern Medical Center ...........................................................................................248 Health Education Authority of Louisiana (H.E.A.L.) ..................................................257 Tulane University Hospital ..........................................................................................266 Charity Hospital, the de facto Black Hospital .............................................................272 Court Cases and Federal Investigations .......................................................................273 Grassroots Activism and Federal Programs .................................................................278 CHAPTER 8: BLACK HEALTH CARE IN THE AGE OF CRISIS, 1975-2005 ..........290 Introduction ..................................................................................................................290 Flint Goodridge's Decline ............................................................................................292 Corporate Health Care .................................................................................................299