The University of Alabama Press, 2025
Reviewed by Stephen W. Russell, MD
Professor Jack D. Ellis’s fifth book, Physicians for the People: Black Doctors and the Struggle for Health-Care Equality in Alabama, 1870-1970, begins in Tuskegee. Fifty years before the unethical U.S. Public Health study that withheld treatment from 400 Black men with a treatable disease, the Tuskegee Institute represented a bright future for Alabamians. With the backing of the eminent Booker T. Washington in 1881, Tuskegee aimed to be known as “an agent of hygienic reform” based on scientific discovery under “the leadership of Black physicians.” Yet almost a century after this auspicious beginning for the Institute, the name Tuskegee came to represent an indelible stain on the fabric of race relations in Alabama. What has changed?
Ellis’s story aims to answer that question. Based on a series of interviews and oral histories of medical providers during the 1960s Civil Rights era, Ellis’s narrative allows the participants to tell their stories. The resulting Physicians for the People offers a taut timeline of resilience in the face of inequity.
Readers need only an elementary understanding of American history after the Civil War to come prepared to appreciate what Ellis has written. For Alabama’s Black citizens, the bright hope of healthcare from the Tuskegee Institute dimmed with the advent of Jim Crow laws, the disenfranchisement of Black voters, and the closed doors of educational opportunities. But at this point in the narrative, Ellis pivots, highlighting the roots and fruits of these resilient Black doctors contrasted against the shadow of discrimination.
The lack of educational opportunities for Alabama’s Black students could not obscure their aptitude. Ellis describes Alabama’s earliest Black doctors. They were the sons of land-owning rural farmers. They attended one-room schoolhouses, showing an interest in science, demonstrating their “hidden strengths.” They also had to leave the state to become doctors. Alabama would not admit its first Black medical student until 1965.
Returning home with a doctor’s diploma did not guarantee financial security or a supportive medical community. “Nonwhite doctors earned less than half of what their white counterparts earned,” Ellis writes, and not until the 1960s introductions of Medicare and Medicaid would these physicians improve their financial situation. Black physicians were also excluded from the ranks of specialty-trained physicians during this time. “The relationship of Black doctors with their white colleagues was tenuous,” Ellis writes, made even more difficult by the dependence of Black physicians on their white sub-specialty trained colleagues. As a result, Black patients suffered.
Still, Ellis devotes much of the narrative to describing how Black doctors responded. In one Depression-era example, a Tuskegee alumnus who returned to Alabama after medical training in Nashville responded to the local need. Black infants died at twice the rate of Alabama’s white infants, a consequence of inaccessible maternal medical care for Black mothers. Partnering with the Black community—churches, businesses, and clubs—this doctor helped create a neighborhood “emergency station” for Black doctors and their pregnant patients called the “Southside Clinic.” Within months of opening, this clinic could claim “forty-two deliveries with no infant or maternal deaths,” a striking improvement from the status quo.
Clinics such as this were needed because Alabama’s segregated hospitals had very few beds designed for Black patients. Those beds were often separated from the main hospital, prompting one reporter to describe them as “‘basement hospitals’ for Negros.”
In the pre-Civil Rights era in Birmingham, white community leaders led a systematic effort to exclude Black doctors from county medical societies, hospital admitting privileges, and medical education. A decade before the University of Alabama admitted its first Black medical students, the head of the medical school’s Department of Medicine refused to integrate the hospital so that Black doctors and their patients had access to state-of-the-art medical care. Justifying his position, the University physician cited the “regulation which limits the use of the hospital to members of the Jefferson Country [Birmingham] Medical Society,” even as he knew that the Society “had inserted the word ‘white’ into its bylaws regarding those eligible for membership.”
The most enduring historical narratives tell not just the story of the past but the story of ourselves. In reading them, we question how we would have acted in a similar situation and wonder about who we would be if the past had played out differently. Ellis distills powerful vignettes from the oral histories he collected to do just that.
In one memorable example, the first Black board-certified surgeon at University Hospital in Birmingham recalls his initial visit to the hospital’s segregated ward. “Black patients lay crowded in the basement under sewer and water pipes,” he tells Ellis. “I remember walking out of there the first time and asking myself, ‘What did Black folks do to white folks to be treated like that?’”
It’s a question that resonates throughout Physicians for the People. If we conclude, as Ellis does, that there is no rational answer to that question, then this story allows us to use the past to imagine a better future.
Stephen W. Russell, MD, a native of Alabama, is a Professor of Medicine and a Primary Care Physician at the University of Alabama at Birmingham (UAB). He is the author of medical thrillers, including Blood Money and Command and Control, both of which were previous Amazon bestsellers.
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