"As Good as Money Could Buy": Kansas City’s Black Public Hospital
“They did not try to build something ‘good enough for Negroes’ but something as good as money could buy.” This is how Chester Arthur Franklin, the Republican founder of The Call newspaper and one of Kansas City’s most prominent black leaders, greeted the newly constructed eight-story building that housed General Hospital No. 2, serving the indigent African American population of Kansas City. When the new building opened on March 2, 1930, national public health experts joined the local black and white communities in considering the new facility to be the finest black public hospital in the nation, even rivaling some of the best white public hospitals with its state-of-the-art equipment and modern architecture.
Kansas City’s new General Hospital No. 2 replaced a dilapidated 50-year-old building that had served as the city’s separate black public hospital. Highly unusual, and perhaps unique nationally in 1930, the city’s black patients now had access to municipally funded care at a newly constructed hospital building, staffed, and supervised completely by black physicians, nurses, and administrators. In both 1931 and 1932, the National Negro Health Contest rated Kansas City as the top city for black health. The moment of the hospital’s opening marked a point of pride for the black community and promised to usher in a golden age of public health and improved living conditions for African Americans in Kansas City. Yet despite being “the best money could buy,” with a new building and modern equipment, public fanfare, and promises of racial equality in a segregated facility, the new construction papered over a number of institutional weaknesses that reflected Kansas City’s contentious racial and community politics. Even as the new hospital swept up accolades, however, it also reached its apex of patronage appointments, corruption, and political interference from the local Democratic machine controlled by Thomas J. Pendergast.
Public health provisions had been a point of contention—especially along racial lines—since Kansas City opened its first city hospital in 1873, at present-day 22nd Street and Kenwood Avenue. For decades, the public—white and black—had little trust in the institution. As the city’s population exploded, in the late 19th century, the facility became overcrowded, requiring beds to be set up in hallways, and sometimes two patients shared one bed. An all-white staff treated black patients on a segregated basis, and in later years, an article in the Jackson County Medical Journal acknowledged that black patients “took what treatment they could get.” In 1908, hospital spending each day for white patients more than doubled that for black patients in the same facility. Combined with poor living conditions, the lack of care contributed to blacks in Kansas City dying at a much higher rate than whites, including an infant mortality rate two times greater.
A catalyst for change occurred in 1903, when the city suffered a debilitating flood that overwhelmed the capacity of the municipal hospital, which was originally constructed when the city’s population was just one-seventh its size at the time of the flood. The downtown Convention Hall served as an emergency hospital, with black patients segregated under the care of Dr. Thomas C. Unthank, who had earned his M.D. at Howard University and set up practice in Kansas City in 1898. The catastrophe convinced the city to build a new public hospital, and Unthank took the lead in advocating that the old city hospital building be converted into a separate hospital for minorities that should be staffed at least in part by black doctors and nurses.
The new white hospital became known as General Hospital No. 1, while the old building became the “colored division” of the city hospital, or General Hospital No. 2, opening in 1908. Overcoming resistance from members of the white community who did not believe that blacks could be competent medical practitioners, the hospital started admitting black physicians, interns, and staff in 1911, and by 1924 it had an all-black staff and administration. Officially the hospital remained the “colored division” of the city hospital, and white physicians continued to serve as “supervisors” or, in reality, occasional consultants for each department.
Black patients who could afford treatment from private physicians or hospitals had other (still segregated) options besides the charitable public hospitals for the indigent. Nationally, about 3,500 black physicians had received training by 1920, and in Kansas City a few dozen had established private practices. Shut out from practicing in whites-only hospitals and highly unlikely to treat white patients in general, some established their own private hospitals intended specifically for the black community. In Kansas City these included Dr. John Edward Perry’s Sanatorium, Dr. Unthank’s Lange Hospital, and the Douglass Hospital in Kansas City, Kansas. Architecturally, these facilities were typically little more than repurposed houses, but in one case, the Provident Association, a charitable organization run by white Kansas City businessmen, took over management of Perry’s Sanatorium and merged with the Phyllis Wheatley Association to form Wheatley-Provident Hospital, which occupied a former parochial school in 1918.
General Hospital No. 2 tended to be more overcrowded than the private hospitals, but did offer municipally funded care for a large number of blacks, Mexicans, and other non-white residents of Kansas City, Missouri, who could not afford care at Wheatley-Provident or another private facility. Originally, No. 2 offered free care to all patients without any attempts to determine their financial status, but after July 1923, it only admitted patients deemed to be indigent (an inexact and inconsistent determination in practice), or only on an emergency basis for wealthier patients. Another major policy change occurred in 1924, when General Hospital No. 2 started serving African American patients only, while other minorities who had previously been treated there were sent to No. 1.
By 1922, General Hospital No. 2 attained the highest Class A accreditation from the American Medical Association, the black National Medical Association, and the American College of Surgeons. It also became a center of black medical training for newly minted doctors. Only 125 black doctors were graduating in the United States per year in the mid-1920s, with many coming out of the largest black medical schools of Howard University and Meharry Medical College in Nashville, Tennessee. For these doctors, fully half of all accredited internships were offered in Kansas City or in St. Louis in the mid-1920s. The white doctors who served at No. 1 and many of the black doctors at No. 2 (but not the senior administrators, nursing, and other full-time staff), served as unpaid volunteers for the charitable cause of treating indigent patients.
Defining a Political Space
The construction of the new General Hospital No. 2 in 1930 was the culmination of political influences that resulted from African Americans in Kansas City shifting their support from the Republican Party to the Democratic Party and its local political machine led by “Boss Tom” Pendergast. The moment closest to a tipping point in this shift occurred around the 1924 elections, when the Democratic Party across Missouri distanced itself from the resurgent Ku Klux Klan. The state party followed the lead of Democratic machine bosses in St. Louis and Kansas City, who had associated themselves with immigrant and minority communities, as well as Catholic leaders and interests who were opposed by the Klan.
Racialized politics were nothing new to the medical scene in Kansas City. Dr. Milton C. Lewis, a graduate of Howard University who came to General Hospital No. 2 as an intern in 1920 and later continued as a regular staff member, observed that black physicians who wanted a successful career had to do more than possess medical skill; they also had to navigate the city’s political environment. The superintendent of the hospital, by Lewis’s description, "was appointed by the head of the party which won the city election and was responsible to this man and to a lesser degree to the Hospital and Health board." For all physicians, white or black, achieving success required joining the Jackson County Medical Society (JCMS), itself divided by political rivalries. For black doctors to succeed, they additionally needed to "be [recommended] by a white doctor, call in a white doctor, or be exceptionally good."
In a brief memoir, Lewis expressed his belief that the local black medical profession was dominated by two groups, which “were constantly at each others throats engaged in bitter personal, medical and political feuds.” The first group consisted of Republicans, or the “majority of the better class Negroes,” as he described them. He elaborated that this first group “had the ear of [the] white people. They had the [confidence] of the public.” The second group, “composed principally of politicians,” in his view, was made up mostly of Democrats. Lewis believed himself to be a part of a third group of younger doctors who attempted to avoid entanglements with the other two groups.
The Democratic doctors were the ones who prevailed following the adoption of a new city charter in 1925. The Pendergast machine coopted the new reform government by capturing five of the nine city council seats, giving the machine control in the hiring of the city manager. The machine selected Henry F. McElroy, who took charge in April 1926 and wasted no time in establishing authority over the city’s health director. Publicly, McElroy stated that he simply disagreed about the color of paint that Dr. E.W. Cavaness had selected for the nurses’ quarters at General Hospital No. 1, and the city council soon had Cavaness removed by a five-to-four margin. The real conflict, of course, was about Cavaness’s refusal to fill job openings with Pendergast’s political appointees, but the “paint color” dispute sent an irrefutable message about the machine’s power. After just six months, 42 percent of Kansas City’s municipal employees had been replaced.
As this transition in city government occurred, Lewis described a new alliance forming between General Hospital No. 2’s Democratic physicians and his own cohort of younger doctors, who had, at least in Lewis’s view, remained neutral in hospital politics. Whatever his misgivings about the Democratic physicians being “politicians,” Lewis described them as being, “on the whole of good caliber.” The Democrats and young doctors captured the positions of staff president and secretary of the staff, with Lewis assuming the latter position. The old guard Republican faction maintained control of the surgical service, but was otherwise marginalized in hospital authority.
Confirming other accounts, Lewis observed that “politics entered more and more into the affairs of the city hospital and a point was reached where the superintendent could not fire [an] orderly without the consent of some political boss.” Corroborating Lewis’s account, the JCMS’s publication, the Jackson County Medical Journal, claimed in 1933 that doctors had “to go to a political boss to gain his support before being considered eligible for appointment . . . [and] the candidate’s real or imagined control of a block of votes [was] the chief consideration for appointment.” White and black doctors, it seemed, needed to promise to deliver the votes of their patients in addition to healing them.
Dr. William J. Thompkins, a physician and former head of General Hospital No. 2, had recently risen in the ranks of regional Democratic politics and was appointed assistant health commissioner in a newly established hygiene department. With Pendergast’s backing and in partnership with Felix Payne, Thompkins began publishing a Democratic rival to The Call, named the Kansas City American, in 1928. A portion of Kansas City’s black community had entered into an arrangement with the Pendergast machine, with the proposal for a new hospital emerging as a leading mutually beneficial development. The stakes were high; by 1930, General Hospital No. 2 accounted for 95 percent of all professional and semiprofessional black employees of the municipal government of Kansas City, Missouri, making it the city’s most fertile ground for political patronage in the black community of some 40,000 persons. (It should be noted that Lincoln and Sumner High Schools, Wendell Phillips Elementary, and other segregated public schools were part of the city’s school district and not directly controlled by the municipal government or the Pendergast machine.) Excluding volunteers, the hospital employed an all-black staff of 292 individuals, including 72 professionals made up of doctors, dentists, and nurses. A full 70 percent of Kansas City’s black physicians—35 in all—served as staff members for General Hospital No. 2 on a full- or part-time basis.
The New Building
The need for a new building would have been obvious to any nonpartisan observer. As early as 1923, a committee, including white civic leaders such as the philanthropist William Volker and several doctors, formed to advocate for a new black hospital. They described the conditions at the 50-year-old building: “Mental patients there must be chained to their beds to protect other patients. The building is dilapidated. It has been patched up time after time and it is simply worn out.” That same year, a committee of the JCMS noted that wall plastering was falling off and that the building was “infested with rats and vermin.” Interns lived “in an attic,” and nurses lived in a “frame building in a miserable state of repair with leaking roof and inadequately heated and terribly over-crowded.”
The successful 1925 bond issue did not move the project along very quickly. The original site proposed for the hospital was at the present-day Nelson C. Crews Square, just north of Spring Valley Park near 27th and Euclid Avenue. This location was at the extreme southern point of black settlement in Kansas City, prompting objections from the Linwood Improvement Association, which represented hundreds of white homeowners located to the south of 27th street. The association claimed “a legitimate right to protect values of property that have been honestly earned,” and feared that construction of the hospital nearby would encourage blacks to take over Spring Valley Park, move into homes south of 27th street, and depress property values. Their opposition forced a relocation of the planned hospital.
The black community soon blamed Henry McElroy for the construction delays. In his capacity as assistant health commissioner of the hygiene department, Thompkins completed a study of health conditions, housing, and sanitation in the city. His publicized findings underscored the need for a new hospital, and his connections to the Pendergast machine and the national Democratic Party lent weight to the campaign for a new hospital. Numerous appeals were made to the Pendergast machine, and in the end, the Kansas City American and other sources credited Tom Pendergast with moving the project forward.
What finally spurred construction plans, though, was a fire that spread through the existing building in July 1927. It endangered the lives of 60 patients and caused $30,000 of damage. The city finally approved plans for construction in 1928, with the building to be sited near the old one and General Hospital No. 1, at what is still known as Hospital Hill. Built at a cost of $300,000, it was located at 600 East 22nd Street and opened on March 2, 1930, to great fanfare.
The new hospital promised to be a lifesaver for African Americans who had long suffered in the decrepit old facilities. Aside from The Call labeling it the “best money can buy,” the paper lauded it as the “most modern public hospital in the country now ready for occupancy,” presumably even in comparison with white municipal hospitals. The facility was “spic and span” and had “the most modern design” and “the best equipment available.” In addition to details about various medical resources, the Jackson County Medical Journal proclaimed, “Everything has been done to make the new General Hospital for Colored Patients, cared for by Colored Physicians and Attendants, a pleasant and inviting haven of refuge for the indigent sick, a pride to the city, and a boon to its colored citizens.” The building was supposedly fireproof, with concrete or tile floors.
Even before the machine established full control over the city’s health board, the board had moved to build a new black hospital, among several other public health facilities. A bond in the amount of $1.2 million passed by the end of 1925, but plans for construction were delayed until a location suitable to all interests could be found.
Deficiencies, Political Patronage, and Corruption
Unfortunately, beneath the shiny façade of a new building, countless problems lurked. As noted, a change in superintendents and other key positions had regularly coincided with elections prior to 1925. But through Henry McElroy, the Democratic machine tightened its grip, maintained control for 13 years, and ultimately proved a mixed blessing for black medical care and public health.
Alongside machine support and the headline project of a new building, a pattern of chronic deficiencies in medical supplies and staffing plagued it, a pattern that fit well within the national trend of black public hospitals being shortchanged relative to their white counterparts. In his memoir, Milton Lewis initially concurred with all of the fawning publicity, writing that the “new hospital had been built fully equipped.” But, he added, “before long the whites at No. 1 had eased a [quantity] of [essential] equipment from No. 2. Nothing was done about it.” While it does not appear that this equipment was anything as expensive or obvious as an X-ray machine, oral histories have established that the black hospital suffered from a chronic shortage of day-to-day supplies such as needles or syringes, even years after the machine fell.
Some of the initial problems resulted from machine infighting that took place about six months after the new building opened. Casimir “Cas” Welch, a boss leader who had allied with Tom Pendergast in 1925, broke with Pendergast in August 1930 to have Dr. Howard Smith, the hospital’s superintendent and a Pendergast appointee, removed and replaced by Dr. D.M. Miller, who besides being a loyal Democrat, was best known for a scandal wherein he physically abused residents at the Home for Aged Negroes. The Call reported a decline in the quality of medical services, bedpans sitting unattended for 24-hour periods, hospital staff demanding what amounted to bribes from patients, and a payroll that had been padded in the amount of $40,000. Pendergast did not reassert control of the hospital until late-1932, reportedly restoring some measure of competency to the hospital administration, but not abandoning other corrupt practices.
Deficiencies extended far beyond a rogue political boss. According to interviews of Dr. J. Harvey Jennett (the superintendent of General Hospital No. 1 from 1932 to 1936), the superintendent had no authority to hire staff. Only the city health director could do so. In practice, though, the health director answered to McElroy, the city manager who appointed him. Approval for much of the hiring, down to the lower level jobs, went all the way up to Tom Pendergast himself.
The architectural design—although widely praised in newspapers and considered the best in the nation for a black public hospital—received harsh criticism from a health and hospital survey conducted for the Chamber of Commerce in 1931, which found that, “throughout the building there are many evidences that the hospital was not planned by one familiar with the administration of a hospital.” Hot steam from exposed radiators threatened patients in the psychopathic ward, and privacy partitions for toilet facilities had already been ripped down by violent patients.
Worse still, the space reserved for the morgue had no ventilation and had to be abandoned. As a result, the report noted, it was “necessary to transport the bodies of deceased patients across the lawn, down a flight of steps into the basement of a building which also serves as nurses’ dwelling.” That space, located in the old black hospital building, was also unventilated, making it “probable that unpleasant odors arising during post-mortem examinations will penetrate into the nurses’ living quarters.” To avoid overcrowding, which affected both the black and white public hospitals, the survey found that the new building should only have held 110 beds – not the 179 it had. Some patients had to be kept in the hallways of both the white and black hospitals.
For black nurses and doctors alike, segregation and other restrictions imposed on hospital operations limited their opportunities for professional development and their effectiveness in treating patients. Although apparently not a part of official policy, it was widely known that patients were sometimes transferred to General Hospital No. 1 for advanced surgeries, certain X-rays, or consultations with white specialists. Sometimes patients were transferred underground through a steam and maintenance tunnel that connected the two buildings. Likewise, black physicians and nurses who wanted to observe surgeries or access training opportunities had to seek it out informally at No. 1.
Political corruption and patronage continued to overshadow medical concerns, with some individuals benefiting greatly from machine connections. Citywide, some 1,700 people were on the payroll but not actually employed by the city. In exchange for patronage, the machine expected reciprocation. During campaigns, appointees had to give a bribe or “lug” of 20 percent of one month’s salary to the machine. In order to make up for deficits created by Henry McElroy’s so-called “country bookkeeping,” each year all city employees were expected to request a pay reduction of between 25 and 50 percent for several months. In the “bloody election” of 1934, in which ballot boxes were stuffed and four people were killed at polling stations, the machine released a number of city employees to work elsewhere on election day. Dr. Arthur E. Wells, a candidate for the city council who opposed machine involvement in the city hospitals, was beaten up on election day, just as the machine had threatened.
The Pendergast machine eventually collapsed in 1939, with Tom Pendergast sent to prison for tax evasion. McElroy left the city with an unreported deficit of $19,453,976 in general accounts, plus fraudulent spending of more than $11.4 million out of the Ten-Year-Bond funds (paid without contracts or competitive bidding). In the same year, the American Medical Association revoked its accreditation for internships at General Hospital No. 2. In the prior year, the number of interns had already dropped off dramatically to just one individual. Meanwhile, the new reform government swept out McElroy’s latest appointed director for the department of health, Dr. Edwin H. Schorer.
The city’s reform government set up a bipartisan governing body in 1942, but General Hospital No. 2 continued to suffer from a scarcity of supplies and training opportunities. In 1946 and 1947, black doctors protested the supply shortages and, while not going so far as to declare a general strike, they refused to perform elective surgeries or other non-emergency services. The city acquiesced to some of their demands, and the American Medical Association renewed its accreditation for the hospital in several areas of practice. In the same years, the city issued bonds to construct new wings at both public hospitals, finally addressing the overcrowded conditions. Staff shortages at No. 2, on the other hand, were more difficult to resolve because of an ongoing national shortage of black doctors.
In some respects, then, it remained business as usual at General Hospital No. 2, but Milton Lewis reflected that the fall of the machine “was the beginning of the end for all Negro doctors as far as the hospital was concerned[,] for the Negroes could once get political aid but those days are gone.” The hospital increasingly relied on white doctors as attending chiefs of service instead of supporting the professional development of black doctors. Writing sometime after 1947, Lewis bemoaned 25 years of “poor leadership” and stated that, “The Negro medical profession is at the lowest depth since 1925.”
Increasing costs and political pressures amidst the Civil Rights Movement ultimately made it difficult for Kansas City to sustain two separate facilities for whites and blacks. In 1957, the city council decided to consolidate General Hospitals No. 1 and No. 2, and black patients and staff moved into No. 1 in 1959. In 1962, the city continued to provide funding for the hospital, but it turned over management to a nonprofit organization that renamed it General Hospital and Medical Center. In the early 1970s, General Hospital was replaced by the Truman Medical Center, which still operates on Hospital Hill today.
If the history of General Hospital No. 2 in the 1920s and 1930s is considered alongside black public hospitals in other American cities, the arrangement between the Pendergast machine and the black medical community appears to have worked to the advantage of the black community. The public praise heaped on General Hospital No. 2, especially for the efforts of its staff and administrators, as well as for the newly constructed building in 1930, seems understandable in comparison with other black city hospitals nationwide. Indigent black patients maintained deeper trust for the care they would receive from doctors and nurses of their own race, and they generally did not have to wait in line behind white patients for treatment. Hospitals are usually not at the forefront of discussion about community formation and uplift, but in General Hospital No. 2, African Americans had successfully lobbied for an institution that they could be proud of and, at least in comparison to most other cities, rely on for their medical needs.
Of course, none of these positive developments suggest that black patients received equal care to the white patients at General Hospital No. 1, or that black physicians had equal opportunities for professional growth to white doctors. Even under the best of circumstances, with political support from the Pendergast machine at its highest levels, the experiment faltered in the space of a decade, and the program was restructured in a way that left local black doctors excluded from the professional opportunities available at the white hospital.
In sum, General Hospital No. 2 probably was the “best money could buy,” as originally described in The Call, but only in an ironic sense: increased funding, industrious physicians, and community support could not compensate for the effects of political corruption and overtly racist policies against black doctors and patients.