April 1, 2020
- Outlines the trailblazing work of Dr. Burrell and colleagues in establishing surgical care for African-American patients
- Describes the evolution of BMH—the first successful black hospital in Roanoke, VA
- Highlights the enduring significance of the black hospital movement
Editor’s note: The American College of Surgeons (ACS) History and Archives Committee (HAC) hosts an annual Poster Competition at the ACS Clinical Congress. The following article is based on the first-place winner of the HAC Poster Competition at Clinical Congress 2019 in San Francisco, CA. An article based on the second-place winning poster will be published in the May issue of the Bulletin.
At the turn of the 20th century, African Americans faced significant segregation and discrimination in accessing surgical services. Black physicians and patients both were excluded from white hospitals. Critical demand for surgical facilities in black communities across the U.S. motivated the development of notable black hospitals, including Provident Hospital, Chicago, IL, and Baltimore, MD; Lincoln Hospital, Durham, NC; Mercy Hospital, St. Petersburg, FL; and Howard University’s Freedmen’s Hospital, Washington, DC.1,2
Dr. Burrell in 1910. (Courtesy of Harrison Museum of African American Culture, Roanoke, VA.)
In Roanoke, VA, a small city in eastern Appalachia, Isaac David Burrell, MD, a prominent local physician, died of complications from cholelithiasis in 1914. Dr. Burrell died because he was denied surgical care at a local hospital because of his race, and, as a result, he had to travel 250 miles by train to the nearest hospital that would operate on him. His partners, a group of black physicians in the community, were inspired by heartbreak to form Burrell Memorial Hospital (BMH) in 1915. The institution was a vital cornerstone in the community for more than 60 years. The hospital and its founders have remained relatively obscure; however, their contributions to the surgical care of black Appalachians served as an exemplary model to other black physicians of the time.
To learn more about Dr. Burrell and his namesake hospital, the authors conducted a systematic review of the historical archives at the Virginia Room at the Roanoke Public Library, examined historical newspaper archives, and conducted (n = 10) interviews with former nurses, graduates, administrators, and physicians at BMH. This article summarizes our findings.
Dr. Burrell was born March 10, 1865, during the Civil War in south central Virginia. He graduated from Leonard Medical School at Shaw University near Raleigh, NC, in 1893 and later moved to Roanoke where he was a general practitioner and owner of the only pharmacy that served the black community at the time.3 Dr. Burrell formed a practice of eight black dentists and physicians and became a prominent physician through his service as founder and president of the local Magic City Medical Society.4
Surgical care was less accessible to African Americans living in Appalachia than it was for their counterparts in major metropolitan areas, where blacks were more highly concentrated in the early 20th century. Black Appalachians not only were denied treatment at whites-only hospitals, but also frequently had to travel hundreds of mountainous miles to obtain care.5 For the 15,000 black residents of Roanoke and surrounding Appalachia, the closest facility was more than 250 miles away at Howard University’s Freedmen’s Hospital.6 As groups of black physicians across the country began discussing the need for surgical facilities, Dr. Burrell and his colleagues laid the groundwork for a facility to serve the black populations of Roanoke and Appalachia.7
In 1914, before the plans for the hospital were realized, Dr. Burrell developed acute cholecystitis. At the onset of his acute condition, no local hospitals permitted admission of African Americans. His partners petitioned for operating privileges to no avail. Instead, Dr. Burrell was placed on a cot in a boxcar and transported to Freedmen’s Hospital. Although it is unclear whether he died prior to operative management or shortly thereafter, his death galvanized the Roanoke black community to raise the funds to open BMH in 1915. Dr. Burrell’s untimely death highlights the barriers many rural blacks faced at the turn of the last century.8
BMH was not the first black hospital in Roanoke, but it was the first to succeed. Its predecessors included Medley Hospital, established in 1913, and Charity Hospital, founded in 1914.9 It is unclear why those hospitals closed, but BMH simply may have been better funded. All three hospitals were formed to address the need for a surgical facility for black residents of eastern Appalachia (see Figures 1A and 1B). Lylburn Clinton Downing, MD, a black surgeon, was elected as the first superintendent of BMH at the opening of the hospital in March 1915.
BMH was a pioneering institution. In 1965, the Roanoke Times, the local newspaper, reflected on the hospital’s impact at the time of its 50th anniversary: “From the beginning, Burrell Memorial Hospital attempted to exercise one of the most important functions of a hospital, a teaching institution.”10
The founders of the hospital recognized its importance in providing not only excellent care to the community, but also in offering superior training to future health care professionals. Although the hospital initially was little more than a residential house with many windows that provided optimal lighting for surgical procedures, it grew quickly as a training ground for black nurses. In 1925, BMH gained accreditation as a nursing school and nurses from Burrell were soon sought after in operating rooms and hospitals throughout the region (see Figure 2). The community was immensely proud of the graduates. According to Yvonne Tinsley, LPN, who was a graduate of the nursing program in the 1960s, “When you went to another hospital and stepped into an operating room, they could tell that [that] was a Burrell graduate.” (Personal communication with Yvonne Tinsley, August 27, 2019.)
Figure 2. BMH Nursing School
Throughout the 1930s and 1940s, BMH grew as a leader among many black hospitals in the U.S. BMH was one of more than 100 hospitals in the U.S. that provided care to African Americans in the early 20th century.2,11 In 1935, BMH was the first black hospital in the Commonwealth of Virginia to gain accreditation from the ACS, marking it as a center of excellence, and one of the first black hospitals in the U.S. to be accredited by the College, the precursor to The Joint Commission.9 By 1945, only 23 black hospitals had received ACS accreditation.12 Members of BMH led the training of the Hunton Life Saving and First Aid Crew that formed in December 1941. It was reputedly the inaugural all-black trauma first response team in the U.S. (see Figure 3).
Figure 3. BMH Hunton Life Saving and First Aid Crew
In the course of more than 60 years of operation, BMH inhabited three buildings (see Figure 4). With an initial loan of $1,000, the hospital was chartered under the laws of Virginia.13 Although the hospital faced many financial difficulties in its first years of operation, patient volume grew steadily, as did the physical size of the hospital. The first building was a 10-bed facility located in the historically black Gainsboro district of Roanoke. In 1921, the hospital moved into an old schoolhouse, expanding to 55 beds.
Figure 4. Timeline of BMH, 1915–present
In 1946 the U.S. Congress passed the Hospital Survey and Construction (Hill-Burton) Act, which provided federal funds to states to ensure equitable health care facilities were available to all Americans. It also prohibited racial discrimination at hospitals receiving federal funds. The act provided much-needed financial backing to BMH and other ailing black hospitals of the time. Using these funds, in 1955 BMH opened a state-of-the-art 80-bed facility with three operating rooms. The first operation performed in this new facility was an appendectomy.
At the peak of operations in the 1960s, BMH was a modern and technologically advanced center where approximately 950 surgical procedures were performed annually. With full-service radiology and pathology services, the hospital grew to be a regional center, drawing in referrals from more than 80 miles away (see Figure 5). Newspapers at the time reflected on the hospital’s innovative approach to patient care, noting that the staff was the first in the nation to include a full-time dietitian and full-time social worker.10 Although it is unclear when the hospital employed these members of the health care team, the leaders at BMH recognized the importance of providing well-rounded and interdisciplinary patient care.
Figure 5. Reach of BMH services circa 1950
For better or for worse, federally mandated desegregation of hospitals in 1963 exacerbated the many financial difficulties facing black hospitals across the country.8 BMH faced the same struggles, and eventually closed its acute-care facilities in 1979. In reality, the hospital had faced financial struggles as early as 1930, in part because of the Great Depression, but also because throughout its existence the hospital cared for the majority of low-income and uninsured residents of Roanoke. The hospital largely remained solvent as the result of vigorous fundraising efforts, but by 1990, BMH had been converted to a nursing home and now serves the community as a mental health facility.14 Although not well documented, few historically black hospitals remain independently operated today.15
BMH was established during the black hospital movement (1860s–1940s), during which approximately 120 hospitals were formed across the U.S. to address the health care needs of African Americans.16 BMH and its staff proved to be one of the leaders in this movement, particularly Dr. Downing, who, as mentioned previously, was the first administrator of the hospital and was a driving force in establishing surgical care for black Roanokers.
Dr. Downing was born in 1889 in nearby Danville, VA, and graduated from Howard University Medical School in 1912. After completing his surgical training at Freedmen’s Hospital, he started his own practice in Roanoke. Without the use of a hospital facility, Dr. Downing performed his first operation with the assistance of two other black physicians November 8, 1913, in a private home. The operation was the first by a black surgeon in the region and was recorded simply as an “abdominal procedure.”
Dr. Downing devoted the rest of his career to improving the quality of care of black Americans across the country. He served as the vice-president of the National Hospital Association and spoke widely across the country about establishing surgical centers for African Americans. He became a member of the American College of Hospital Administrators and later served as vice-president of the National Medical Association. He recognized the need for black hospitals to be centers of excellence, writing that hospitals needed “modern equipment, an egalitarian approach to staff activity and organization, and a modest number of beds.” However, he was foremost a surgeon, remarking that “no expenses [could be] spared for the operating room.”17
Another surgeon, Maynard Herman Law, MD, succeeded Dr. Downing in 1954. Dr. Law also trained at Howard University and presided over BMH during the key years of federally mandated hospital integration. He was known for his meticulous skill and his desire to ensure fair access to health care for African Americans. He later advocated for BMH to remain an independent facility despite financial difficulties because of his firm belief that blacks would get unequal treatment at white hospitals. The Hill-Burton funds across the country were being misappropriated to white hospitals, and Dr. Law maintained that they should be used to advance care for black Americans.18
The black hospitals in Appalachia were smaller than their better-known urban counterparts; however, by reducing travel time across challenging geography, they served a population that otherwise would have had no access to surgical care. Courageous and imaginative black surgeons did not always have the necessary resources to provide care for their communities, but they worked to provide excellent care regardless of their circumstances.
The story of BMH is in reality the combined dream of many pioneering black physicians in the early 20th century. From Burrell to Downing to Law, these physicians and surgeons were responsible for changing the paradigm of care for a community that did not have access to surgical services.
Dr. Downing wrote in the Journal of the National Medical Association, “A prominent administrator from Washington, DC, visited the hospital a few months ago…and remarked, ‘If the Senators in Washington could but see this hospital which is a vest pocket edition of Freedmen’s, they would not regret a single dollar that had been appropriated to Freedmen’s Hospital.’”13
Today, most Appalachians and marginalized populations across rural America face diminished access to surgeons and evidence-based care. The lessons of BMH and the black hospital movement are an important reminder that surgeons have a role in ensuring adequate access to care for all populations, especially patients in rural areas.