“Outstanding Services to Negro Health”: Dr. Dorothy Boulding Ferebee, Dr. Virginia M. Alexander, and Black Women Physicians’ Public Health Activism

Abstract

An examination of the lives and careers of physician–activists Dorothy Boulding Ferebee (1898–1972) and Virginia M. Alexander (1899–1949) demonstrates how Black physicians in the first half of the 20th century used public health to improve the health of Black Americans and provides insights into the experiences of Black women physicians. I discuss their professional and personal backgrounds and analyze their divergent strategies to address health inequities. Ferebee used her leadership in Black women’s organizations to develop public health programs and become a national advocate for Black health. Alexander, a Quaker, used her religious connections to urge Whites to combat racism in medicine. She also conducted public health research and connected it to health activism. Both were passionate advocates of health equity long before it gained prominence as a major public health issue. An analysis of their work illuminates past efforts to improve the health of Black Americans.

Dr. Fred M. Hopkins, President of the Pennsylvania Institute of Negro Health; Dr. Virginia M. Alexander; Dr. Charles W. Dorsey; and Dr. Dorothy Boulding Ferebee. (Photo courtesy of the University Archives and Records Center, University of Pennsylvania.)

On October 27, 1940, the Pennsylvania Institute of Negro Health, a Black medical organization, honored Dr. Dorothy Boulding Ferebee (1898–1980) and Dr. Virginia Margaret Alexander (1899–1949) for their “outstanding services to Negro health.”¹ Ferebee founded a settlement house in Washington, DC, and spearheaded the efforts of the Alpha Kappa Alpha (AKA) sorority to bring health care to poor Black Americans in rural Mississippi. Alexander opened a private hospital in North Philadelphia, Pennsylvania, and led an investigation of the neighborhood’s social, economic, and health problems. Ferebee and Alexander were colleagues at Howard University and were two of the most distinguished of the 127 Black women physicians then in the United States.²

Ferebee and Alexander both crafted careers that combined medicine, public health, and social activism and were passionate advocates for health equity. Historian Samuel Kelton Roberts has argued that in the mid-20th century Black public health practitioners, influenced by their exclusion from the mainstream field and by their connections with other Black professionals, held an “expansive” view of public health that “allowed them to link a variety of social and political problems to health in ways not normally contemplated by White professionals.”³ Indeed, for Ferebee and Alexander public health sat at the intersection of their medical, social, and political concerns. Their biographies provide a lens that illuminates how Black physicians in the first half of the 20th century used public health to improve the health of Black Americans and to attack the Jim Crow laws.

PERSONAL AND PROFESSIONAL BIOGRAPHIES

Ferebee and Alexander came from vastly different socioeconomic backgrounds. Whereas Ferebee grew up in a prominent family, Alexander endured a hardscrabble early life. Ferebee was born Dorothy Celeste Boulding in Norfolk, Virginia, on October 10, 1898, to Hampton Institute graduates Florence Ruffin Paige and Benjamin Boulding. Her father worked as a railroad clerk and her mother, a former teacher, volunteered in civic activities. Her maternal grandfather, Richard G. L. Paige, served briefly in the Virginia House of Delegates during Reconstruction. Ferebee finished high school in Boston, Massachusetts, living with relatives who were members of the Black elite. In 1915, she graduated with honors from Girls’ High School. Five years later, she graduated from Simmons College, again with honors.⁴

Alexander was born on February 4, 1899, in a racially diverse poor and working class section of South Philadelphia. Her father, Hilliard, who was born enslaved in Virginia, operated a successful riding academy. Her mother, Virginia Pace, worked as a housekeeper. The family’s finances plummeted after her mother died when Alexander was aged four years and again when her father lost his business when she was aged 13 years. In 1917, she graduated with honors from William Penn High School for Girls and received a scholarship to the University of Pennsylvania, from which she graduated in three years.⁵

In 1920, Ferebee entered Tufts Medical School and Alexander, the Woman’s Medical College of Pennsylvania (WMCP). Ferebee thrived at Tufts. She was an honors student and was elected to Zeta Phi, a medical honor society for women. Alexander initially floundered at WMCP. She failed all her first-year examinations and was allowed to remain in school only if she repeated the year.⁶ She did, and her academic problems never resurfaced.

Both Ferebee and Alexander faced discrimination during medical school. Ferebee, the only Black woman in her class (there were four Black men and five White women), confronted racism and sexism.⁷ She later recalled, “We women were always the last to get assignments in amphitheaters and clinics. And I, I was the last of the last because not only was I a woman, but a Negro, too.”⁸ At WMCP, Alexander, the only Black American in her class, encountered a professor who enjoyed telling “every discreditable, dirty and insulting story” about Black people that he could think of whenever there were Black students in his classes.⁹

By the time Ferebee graduated from Tufts with honors in 1924, internships had become critical for physicians’ professional advancement. However, Black doctors, especially women, encountered steep obstacles in securing postgraduate training.¹⁰ Ferebee, despite her stellar academic record, was one of the few members of her class not offered a position. Her high score on the civil service examination finally led to an internship in 1925 at Freedmen’s Hospital, the federally funded Black hospital associated with Howard University Medical School. Ferebee’s internship marked the beginning of a nearly 50-year association with Howard.

Alexander graduated from WMCP in 1925, and she too faced difficulties obtaining an internship. Even the hospital operated by WMCP was not an option for Alexander and classmate Mae McCarroll because it did not accept Black interns. The school did help them secure positions at Kansas City Colored Hospital in Missouri, where they became the first women interns despite initial reluctance from the hospital superintendent because of their gender.¹¹ After completing her internship, Alexander remained in Kansas City to complete a one-year residency in pediatrics and surgery at Wheatley–Provident Hospital, another Black facility.

DOROTHY BOULDING FEREBEE

Ferebee believed that Black women had a “responsibility for promoting the physical, mental, and spiritual advance of the race.”¹² In 1929, she made her debut as a leader of racial uplift activities when she launched a campaign to establish a Black settlement house in Washington, DC, because none of the existing ones accommodated Black families. The Southeast Settlement House opened the next year and Ferebee served as its board president until 1942, using her medical and public health interests to shape the institution’s activities. In 1937, she served as a member of the Social Hygiene Society’s committee to combat syphilis in the Black community, and under her guidance the settlement house added disease prevention programs.¹³ Ferebee’s experience with the Southeast Settlement House honed her organizing, fundraising, and lobbying skills and cemented her interest in improving the lives and health of poor Black Americans.

Black women’s voluntary organizations became the primary locus for Ferebee’s public health and social activism. In 1937, she was lauded as one “of the backbones” of AKA, the first Black sorority.¹⁴ Her prominence was owing primarily to her leadership of its Mississippi Health Project (MHP), an initiative to bring much needed health care to poor Black Americans in rural Mississippi.¹⁵

In 1934, AKA president Ida L. Jackson led a group of volunteers to Holmes County, Mississippi, as part of an AKA summer program to improve educational opportunities for Black children there. She soon realized that an “educational project can do little for children too hungry and too malnourished to learn” and concluded that a health project was a prerequisite for the success of its educational activities.¹⁶ By December 1934, Jackson had gained sorority approval for a health program in Holmes County, had secured its pledge of $1500 to cover costs, and had appointed Ferebee as chair of the AKA Health Committee and medical director of the MHP.¹⁷ AKA built the MHP on the tradition of Black women, many without health care expertise, taking critical roles in voluntary activities to improve the health of Black Americans.¹⁸

Ferebee became the dominant force guiding the program. During the early months of 1935, while managing her professional and domestic responsibilities (she was married and the mother of three-year-old twins), Ferebee developed budgets, solicited donations, ordered supplies, and recruited 11 volunteers from AKA chapters around the nation, including nurses, clerical assistants, and a dietician. She also adeptly negotiated with public health officials in Washington, DC, and in Mississippi. Dr. Roscoe C. Brown, the Black dentist who led the Office of Negro Health Work at the US Public Health Service, endorsed her efforts and urged her to also seek approval from local officials.¹⁹ The Holmes County Health Officer Dr. C. J. Vaughn informed Ferebee that the county lacked funds to adequately vaccinate Black children.²⁰ Subsequently, she made the immunization of young children the MHP’s primary goal and ambitiously proposed to inoculate 3000 against smallpox and diphtheria.²¹ Vaughn supported the project for several reasons. It would address a public health need without using county funds but would be conducted in cooperation with his department. The temporary health project was limited in scope and duration and thus would not threaten the practices of White physicians. And finally, public health officials recognized that self-protection mandated that Whites could not totally neglect the public health problems of Blacks, especially infectious diseases.

The MHP began in July 1935 after the AKA volunteers had endured a difficult automobile journey from Washington to Mississippi.²² Ferebee described it as “a 2,000 mile run over unknown roads, many without restroom facilities, or over night accommodations, or even gas stations willing to serve Black travellers.”²³ The trip was also dangerous. If there was an accident, the women might be denied treatment because of racial discrimination in Southern hospitals.²⁴

On their arrival, Ferebee and her team encountered a major problem. Initially they had planned to run a centralized clinic at a local Black school. However, they discovered that many of the Black people in Holmes County were sharecroppers who lived virtually in peonage and under the strict control of employers who refused to allow them to attend the clinic.²⁵ Plantation owners feared that the women were outside agitators who had come to incite unrest. Vaughn, signaling his support, accompanied Ferebee as she visited plantation owners. She asserted that her goal was health, not agitation. “Wasn’t it better,” she asked, “to have children protected against diphtheria than to have them die or spread disease?”²⁶ The plantation owners, perhaps out of self-protection, eventually relented, but Ferebee had to give “her assurance that no propaganda was intended” and agree to work under their surveillance.²⁷

Ferebee ingeniously used their automobiles as a mobile clinic. Six days a week the volunteers stocked their cars with medical supplies and equipment and traveled many miles “through dust, dirt, broiling sun, and bad roads” to plantations throughout the county.²⁸ At each location they had to “convert primitive accommodations and facilities into a usable and practical” makeshift clinic.²⁹ Despite these challenges, by the end of the six-week project, they had almost met their goal and had inoculated more than 2600 children. In addition, they had performed more than 200 physical examinations, had distributed 6800 pieces of health literature, and had put more than 5300 miles on the cars in their medical caravan.³⁰

Buoyed by the success of this initial undertaking, AKA funded the MHP for seven more summers. Between 1936 and 1941 Ferebee led volunteers to Bolivar County, but increasing professional responsibilities kept her from returning to Mississippi for the 1942 program. As chair of the AKA health committee, she continued to negotiate annually with local agencies to determine the scope of the mobile clinic. Ferebee declared that the objective of the MHP was “to offer something beyond an academic discussion of the deplorable conditions” of rural Black Americans “who struggle against disease and poverty and exploitation.”³¹

By 1940 the project volunteers had immunized about 14 500 children against diphtheria and smallpox, had treated thousands of adults, had provided venereal disease screening, and had sponsored health education classes.³² AKA took great pride in this public health venture, which brought it and Ferebee many accolades. Surgeon General Thomas Parran hailed the MHP as “one of the best jobs of volunteer public health work he [had] ever seen.”³³ The Pennsylvania Institute of Negro Health proclaimed that Ferebee’s work in Mississippi had “actually saved hundreds of Negro children in the South from too early death.”³⁴ To be sure, the health volunteers brought class prejudices to their work. One AKA publication declared, “Enlightened Negroes . . . must go down, side by side with the humblest, blackest, ‘distorted and soul-quenched’ Negro serf and elevate him by actual contact.”³⁵ But, despite their elitist attitudes, the AKA health workers brought much needed health care to a neglected population.

As historian Susan Smith has cogently argued, “The Mississippi Health Project typified the way in which Black women’s volunteer health work tried to connect public health policy to Black health needs.”³⁶ As a result of its successful endeavor, AKA launched the National Non-Partisan Council on Public Affairs in 1938 to lobby for the interests of Black Americans.³⁷ In March 1940, Ferebee testified on its behalf before a Senate subcommittee hearing on a hospital construction bill.³⁸ She graphically described the woeful conditions she had found in Mississippi and urged the inclusion of a hospital antidiscrimination clause in the legislation.

Ferebee’s leadership of the MHP established her as a prominent, effective, and articulate standard bearer for Black public health issues. Her experiences in Mississippi had given her stark lessons on the impact of racism on health. She saw firsthand that “medical care was sadly lacking where it was most needed because of race prejudice and discrimination which gave the Negro the smallest share in whatever benefits were available.”³⁹ Her work with the MHP also increased her public health practice skills and sharpened her understanding of the links between health and social, political, and economic inequities.

The MHP ended in 1942. World War II gasoline rationing was a factor, but the erosion of support from Mississippi public health officials because they did not fully control the AKA activities proved more decisive. Dr. Felix J. Underwood, the head of the Mississippi State Board of Health, denigrated AKA’s accomplishments. In 1943, he contended that although the sorority “had done some good,” it had “worked pretty much on the loose,” although he admitted that “no untoward results occurred.” Although Underwood claimed that he was “sympathetic” to the need to improve Black health in the state, he insisted that the health department be in charge of all activities and workers. Underwood tried in vain to get the US Public Health Service to assign him a Black woman public health physician who he had heard “could do a lot of good work.”⁴⁰ The doctor he requested was none other than Alexander.

VIRGINIA M. ALEXANDER

By the time she began her internship in Kansas City in 1925, Alexander knew that she wanted to pursue a career in public health. However, when she returned to North Philadelphia in 1927, financial considerations mandated that she start a clinical practice. She began by seeing outpatients in her home. In 1930, she renovated her residence to open the Aspiranto Health Home, a three-bed private hospital used primarily for maternity care but also for convalescent care and minor surgery. She considered Aspiranto a teaching center for the provision of health education and birth control. She also wanted to link the facility to broader social concerns. Alexander saw Aspiranto as a refuge from the racism pervasive in Philadelphia hospitals.

Contrary to prevailing medical and political ideology, even among Black physicians, she called hers a socialized medical practice that exemplified service to the community.⁴¹ Alexander’s founding of Aspiranto garnered praise as “an example of intelligent practical health work for Negroes,” one the Pennsylvania Institute for Negro Health would later cite in its commendation.⁴² Alexander’s medical career blossomed. She maintained a “large, but by no means lucrative” outpatient practice.⁴³ By 1933, she had treated more than 2000 patients in her office or in their homes, often without charge.⁴⁴ Her reputation extended outside the Black community. At a time when the color line in medicine was rigid, she treated Black and White patients.

Religion greatly influenced Alexander’s public health and political activities. After she returned from Kansas City, she developed a deep interest in Quakerism. A strong proponent of interracialism, she believed that interracial dialogue was an effective tool against prejudice because it advanced tolerance and mutual respect. That conviction drew her to attend Friends-sponsored activities, and in 1931 she officially became a Quaker.⁴⁵ For several years she was the only Black Friend in Philadelphia.

Alexander guided the direction of the 1935 Institute of Race Relations, an interracial seminar sponsored by the American Friends Service Committee and the Race Relations Committee of the Philadelphia Yearly Meeting.⁴⁶ As part of the institute, she conducted her first public health research—a study of conditions in her North Philadelphia neighborhood. Writing with what historian David McBride called “articulateness and fire,” Alexander compiled the project’s final report, “The Social, Economic, and Health Problems of North Philadelphia Negroes and Their Relation to a Proposed Interracial Public Health Demonstration Center.”⁴⁷ It presented a bleak picture of the health of Black Philadelphians and the status of Black doctors.

In 1926 Black infants died twice as often as did White infants, and in 1927 Black Philadelphians died from tuberculosis at six times the rate of White Philadelphians.⁴⁸ Alexander attributed these health disparities primarily to social and political factors, including inadequate housing, education, health care, and employment. Alexander vividly documented the role that hospital discrimination played in creating and maintaining these disparities. She discovered that many hospitals excluded Black patients or cared for them in separate wards and clinics. Alexander labeled one hospital “outstandingly unfriendly to colored people.”⁴⁹ She also used the words of Black patients to illustrate the racism they often faced as they sought treatment. One woman described her fears about involuntary sterilization, “I was told to go to Hahnemann for an operation, but I was afraid to go because they always tell you that you need an operation when you don’t, and then you can’t have any more babies.”⁵⁰

The report also revealed that the city’s Black physicians faced steep obstacles. It described “the cold, forbidding, or even discourteous attitudes” they encountered.⁵¹ She observed that when she visited one hospital most of the staff, including elevator operators, “seem[ed] unable to rise to the situation of having ordinary civil or professional relations with a colored doctor.”⁵² Alexander acknowledged the importance of the two Black hospitals, Douglass and Mercy, but conceded that they could not adequately meet the professional and medical needs of the city’s Black population.⁵³ She recognized that her career was anomalous for a Black physician, especially a woman. She was one of only two Black physicians with hospital appointments and one of five with outpatient clinic appointments outside Black hospitals.⁵⁴ Her connections to the city’s White Quaker community certainly advanced her professional standing.

Alexander was the first Black member of the local Friends race relations committee and used her position to advocate the needs of Black health professionals and patients and to translate her research findings into action.⁵⁵ She “forcibly” brought the problem of hospital discrimination to the predominantly White committee and successfully lobbied it to take action.⁵⁶ The North Philadelphia study highlighted the exclusion of Black health professionals from the three municipal hospitals, including Philadelphia General Hospital.⁵⁷ By 1936, the institution had appointed its first Black physician—a result, in part, of Alexander’s work with the race relations committee.⁵⁸ However, Alexander failed in her efforts to get Friends Hospital, a Quaker-operated mental institution, to reverse its exclusionary admission policies and admit one of her patients—a graphic reminder of the widespread racism that then permeated Quaker circles.⁵⁹

As Alexander’s career advanced, she increasingly focused on the role that social factors played in the health of Black Americans. Her interest reflected, in part, the intellectual influence of the prominent sociologist W. E. B. Du Bois, with whom she began an intimate relationship in the early 1930s.⁶⁰ He contended, most notably in The Health and Physique of the Negro American (1906) that racial health inequities stemmed primarily from social, economic, and sanitary conditions.⁶¹ He encouraged Alexander to take graduate courses in sociology at Penn, and she did. However, influenced by her work on the North Philadelphia study, she decided that “disciplined study and research” in public health was more fitting for her professional ambitions, and so she applied to the doctoral program at Yale.⁶²

She immediately encountered a major obstacle. C.-E.A. Winslow, a prominent public health leader and chair of the Department of Public Health at Yale, initially contended that she did not have the prerequisites for admission.⁶³ Alexander recognized that few public health appointments existed for Black Americans, especially women, but she remained steadfast.⁶⁴ She convinced Winslow of her qualifications, and in October 1936 she became the first Black person to study public health at Yale.⁶⁵ Her stay at Yale, however, was short lived. In July 1937, she was diagnosed with lupus, and ill health forced her to leave after one year.

Alexander moved to Washington, DC, in 1937 to accept a position as assistant university physician for women students at Howard University, where she worked under the supervision of Dr. Paul B. Cornely, another physician–activist and public health researcher.⁶⁶ Two years later, they coauthored an article that analyzed the wide gap in health status between Black and White Americans.⁶⁷ Their solutions included the desegregation of health facilities, the creation of public health activities targeted at the Black community, and the passage of the 1939 National Health Bill, which included a plan for national health insurance.

In 1939, Alexander became the supervisor of a health project at Howard funded by the National Youth Administration, a New Deal agency established to provide education, jobs, and counseling for unemployed youths. Two years later, after writing her thesis on the project, she finally received her master’s in public health from Yale, becoming the first Black woman to receive a degree from the Yale School of Medicine.⁶⁸ Alexander’s activism, public health training, and research placed her in the vanguard of Black public health professionals and led to a highly regarded professional reputation. In 1940, the Philadelphia Inquirer hailed her as Black Philadelphia’s “foremost worker in public health.”⁶⁹

Interracialism was at the center of Alexander’s health activism. She believed that White support was critical to any efforts to improve the status of Black patients and health professionals, and she used her Quaker ties to secure it. The Race Relations Committee of the Philadelphia Yearly Meeting was one of the few predominantly White groups in the city that attempted to address racism. Alexander succeeded in persuading the committee to tackle medical racism. She also successfully used her personal story as a Black woman physician and the pain and humiliation that she frequently endured as a way to influence the racial attitudes of Whites, especially Quakers, and to spur them into action.

“OUTSTANDING SERVICES TO NEGRO HEALTH”

After their richly deserved recognition by the Pennsylvania Institute of Negro Health in 1940, Ferebee and Alexander continued battling racial health inequities. Alexander worked for two years (1943–1945) on assignment from the US Public Health Service at the Slossfield Clinic in Birmingham, Alabama, before returning to Philadelphia, where she resumed a limited practice and race relations work with the Quakers. The last years of her life were dominated by illness, and she died from lupus when aged 50 years on July 24, 1949. Ferebee died 31 years later on September 14, 1980 when aged 83 years. Following the 1940 honor, she became president of AKA from 1949 to 1951 and steered the organization to increase its lobbying efforts in health, child welfare, and racial justice.⁷⁰ She also served as president of the National Council of Negro Women from 1949 to 1953.

The careers of Ferebee and Alexander illuminate the substance and character of past efforts to eliminate racial inequities in health and health care. Although the physicians came from different social backgrounds and used divergent strategies in their work, both crafted careers that combined medicine, public health, and activism. Ferebee concentrated on Black women’s organizations, a traditional source of reform within the Black community. With her work with the MHP she tied direct public health services to political activism. Alexander, a strong adherent of interracialism, used her membership on predominantly White Quaker committees to urge Whites to oppose racism in medicine. She also conducted public health research and sought to connect it with health activism. Yet, despite their differing methods, both Ferebee and Alexander were passionate advocates for health equity long before it reached prominence as a national public health issue.