Detroit and the Great Migration 1916-1929, by Elizabeth Anne Martin
The Migrationand the
Health of
African-Americans in Detroit
Even before migrants arrived in the city in 1915, the rate of death among African-Americans in Detroit was 1.5 percent greater than that among whites. By the mid-1920s, however, the African-American death rate had risen to twice that of whites. Much of that increase, unfortunately, was attributable to the numbers and ignorance of the newcomers [1].
Overcrowded and poorly ventilated migrant homes were excellent incubators of disease. Filthy alleys, often heaped with uncollected refuse, made the outside environment just as unhealthful as the inside [2]. Unfortunately, southern customs perpetuated by some migrants made conditions in their homes even more favorable for disease. Infectious germs thrived in the warm comfort of featherbeds, a luxury without which some ex-southerners believed they could not live [3]. Other migrants could not break themselves of the habit of closing all windows at night and heating sleeping rooms by leaving oil stoves and lamps burning [4]. Such a practice not only posed serious fire hazards but also created a very warm, closed environment in which contagious disease spread quickly.
Many migrants knew nothing about immunization, which was not required in the South [5]. As more and more of them crowded into the St. Antoine district, their ignorance facilitated the rapid spread of fatal diseases throughout the densely populated neighborhood. In 1925 African-Americans in Detroit were six times more likely to contract tuberculosis than whites,[6] and an alarming 50 percentt of smallpox victims were non-immunized African-Americans [7].
Unaccustomed to the bitter northern winters, migrants often dressed inappropriately. Insufficiently warm clothing left newcomers more vulnerable than long-time residents to such illnesses as pneumonia, the greatest cause of death among African-Americans in Detroit in the I920s [8]. Too many layers of heavy cotton clothing, on the other hand, cut off blood circulation [9]. This may have led to many cases of heart disease, which was the second biggest killer of African-Americans during the decade [10].
Ailing migrants typically avoided hospitalization [11]. Instead they sought treatment from the same divine healers and "herb doctors" on whom they had relied in the South, as well as on cure-all patent medicines [12]. Divine healers and herb doctors often followed their best customers north. They were able to charge migrants exorbitant fines for their services because individuals of their "skill" were scarce in Detroit [13]. Migrants who formerly depended on travelling salesman for their medicines now purchased them from drug stores in Detroit. Educated Blacks criticized store owners for stocking their shelves with "phony" medicines, but store owners claimed that the demand was too great for good businessmen to ignore [14].
A Black migrant who decided to seek hospitalization had few places to turn in Detroit. Only a limited number of facilities had served the small, pre-war Black population,[15] and with the migration and the subsequent spread of disease in the Black community, these facilities became insufficientt to handle the number of African-American patients brought to them. Administrators of all-white hospitals, however, remained reluctant to admit Black patients, asserting that white patients were "resentful" of African-Americans and objected to "mixing"[16]. Others claimed that ignorant southern migrants would demand treatment for minor symptoms and become "clinic tramps" if more hospitals were opened to them [17].
Eventually, health officials recognized that contagious diseases would spread outside of African-American neighborhoods if Blacks did not receive proper treatment for their ills. As a result, a few small private agencies began providing some care for Blacks in the early 1920s [18]. The Dubois Health Center treated African-Americans, but very few sought care there. The Florence Crittenden home and Dodge Community Center also handled a limited number of Black patients [19].
By 1925 seven of the city's larger hospitals had begun to admit Blacks, although only two hospitals treated more than sixty African-Americans that year [20]. Black patients were given the last beds available at all the facilities that accepted them, and three hospitals reported that Blacks and whites were placed in entirely separate wards. If the African-American beds were full, additional Black patients had to seek care elsewhere [21]
African-Americans in need of emergency care could not simply go to the nearest facility for treatment. Some had to travel across town to find a facility that "had room" for Blacks. Black patients whose family physicians were also African-American found it almost impossible to find a hospital that allowed their doctors to treat them there. Since no white hospital employed Black doctors or nurses, African-American patients had access to modern equipment and emergency facilities only if their physicians were white [22].
Mercy Hospital, which opened in 1916, was the first Detroit hospital that both treated and employed African-Americans. Its twenty five beds, however, were insufficient to meet the, needs of the African-American community [23]. African-American physicians, frustrated at their inability to give their patients the best possible care, founded their own hospital in the St. Antoine District in 1918 [24]. Financed by the Community Fund, Dunbar Memorial Hospital cared for three thousand patients in its first five years of operation [25]. In 1928 the hospital moved to a larger facility capable of accommodating more patients [26].
The Urban League developed its own programs to supplement the reluctant efforts of whites to make health provisions for Blacks. A social worker hired by the League, who tried to visit every African-American newcomer, distributed information On immunization and spoke to migrants about the proper diet and clothing for survival in Michigan [27]. If individuals who were ill were beyond her ability to educate or assist, she referred them to the Board of Health [28].
The Urban League's most ambitious efforts to impress upon migrants the importance of good health came during ananual celebrations of National Negro Health Week. Health Week programs were designed "for the purpose of getting better health results from out newcomers and lessening the death rate [29]. The league sought the participation of the entire community in publicizing and conducting the week's activities. To kick off Health Week, pastors of dozens of Black churches turned over their Sunday pulpits to local physicians, who lectured congregations on current health concerns [30]. Throughout the week, League volunteers travelled door-to-door, distributing literature and advice about health care. Each day had a theme:
Sunday: Sermon and Lecture Day
Monday: Hygiene Day
Tuesday: Community Sanitation (or "Swat the Fly") Day
Wednesday: Children's Health Day
Thursday: Adult Health Day
Friday: Special Campaign Day
Saturday: General Clean-Up Day [31]
Migrants could learn more about health topics by visiting a health exhibit maintained by the League throughout the week [32].
The Detroit Board of Health's annual "Clean-Up/Paint Up" campaign provided the League with another opportunity to educate migrants. Each campaign involved public "mass meetings" on health. Well-known speakers were hired to attract large audiences in African-American neighborhoods [33]. As during the National Negro Health Week, doctors visited local churches to emphasize the need for "cleaning up and painting up" premises so as to create a more sanitary living environment. Volunteers canvassed neighborhoods, urging residents to help make Detroit a cleaner and healthier place in which to live [34].
From the Detroit Urban League Records, Box 87, Bentley
Historical Library
Educating migrants about good health was also a professed concern of the Visiting Nurses Association of Detroit. The association hired African-American nurses to make house calls among the migrants [35]. As an example of the "success" of its efforts, the association printed a part of a "letter," supposedly written by a migrant, in its Annual Report for 1922. Under the heading "Suprising the Home Folks," the excerpt read: "Now honeychile you all never could guess what we's got at our house, so I's gwine to tell you right off de bat, TWINS. Now what do you think of that? ... The doctor sent for the Visiting Nurses to take care of me and the babies and she comes every day, and she's that smart, she knows everything about babies and she hez taught me a heap. She bring me the beautifulest lot of baby clothes 'cause what I made got all burned up. She calls 'em layettes and says some kind of ladies make 'em up and gives 'em to the Visiting Nurses to take to fokls like us" [36].
This "letter" reveals the extremely condescending view many white Detroit institutions had of the migrants. Unfortunately, some migrants were indeed ignorant of modern medical science. In an effort to deal with at least one aspect of this problem, the Visiting Nurses, the Urban League, and the Board of Health worked together to establish a Baby Clinic in 1919 to which hundreds of mothers came to receive instruction in such matters as formulas, pre-natal care, and child care [37]. Clinic organizers later added courses in venereal disease, contagious disease, diet, and post-natal care [38]. Nurses were available at the clinic to administer pre-natal and post-natal care far mothers and babies as well as to investigate the causes of death. In 1920 the nurses saw an average of twenty-five babies per day, and in 1925 mothers made a total of 6,253 visits to the Baby Clinic [39].
The provision of health care information for migrants may have been responsible for the 50 percent decline in the death rate among African-Americans in Detroit from 1919 to 1922 [40]. Education may also have led to lower rates of contracting of tuberculosis among Blacks in the mid-1920s [41]. Certainly, the fact that local hospitals, Black and white, began to serve more African-Americans must have increased migrants' chances of survival in the North. Despite such advances, however, the white community of Detroit was slow to share its health care resources with migrants. Rather than open up more white hospitals to Black patients, the city merely funded separate facilities for Blacks, such as the Baby Clinic and Dunbar and Mercy Hospitals. Unless African-Americans could receive immediate care anywhere in the city, however, their health, and that of all Detroit citizens, was at risk.