The year is 1919. The place is Harlem, New York City. Effective at the onset of the New Year, a new physician is appointed as outpatient clinical assistant, the lowest rank for any doctor at Harlem Hospital. Normally, the appointment would go unnoticed, but not this time. That’s because the entire medical staff of the hospital is white and the new doctor is African American – or "Negro," to use the term of the era.
Harlem Hospital was considered progressive for having added a few black nurses to the otherwise all-white staff two years before, as even in the US North medicine was segregated. The new doctor was a graduate of Harvard Medical School; his father and stepfather were both physicians too, the latter one of the earliest African Americans to receive an MD from Yale. Nevertheless, until now, the only opportunities for an African American physician wishing to do more than general practice lay in small, private, black-run hospitals.
That was the situation on January 1, 1920, when the appointment of Dr. Louis Tompkins Wright (Figure 1) became effective at Harlem Hospital. And when that happened, four physicians resigned in protest, while the doctor who hired Wright was immediately demoted and reassigned to a different hospital.
Barriers for African American physicians
In early 20th century New York City, the medical field was segregated on multiple levels. African Americans and immigrant groups such as Jews all ran their own hospitals, but segregation was most overt for African Americans. Despite deep prejudice, medical advances were discussed and exchanged with white immigrant physicians, as surgeons from the Jewish Mount Sinai Hospital, Cornell, Bellevue, and Columbia Presbyterian, and Harlem Hospital regularly visited one another’s operating theaters – and these were theaters in the literal sense. The operating tables were surrounded by stadium-style seating, and surgeons would give lectures before and during the procedure. This was a way of introducing their colleagues from other hospitals to new operations and went along with reading one another’s papers in surgical journals. Thus, while minority immigrant physicians were excluded from country clubs, they were fully part of the extended medical community, a degree of integration that did not encompass African Americans.
Even so, if anyone was prepared to be a trailblazer it was Wright. He held grueling surgical experience from his participation in World War I, so he added welcomed skill to Harlem Hospital, which not only promoted him to full-time surgical staff but also opened itself to additional African American physicians. In spite of serving a patient population that was primarily African American, prior to Wright’s hiring the medical staff was all-white. A decade later, however, out of 64 in-service surgeons and physicians at the hospital, seven were African American. Furthermore, by the early 1940s, Wright would become the first chief of surgery at an integrated hospital, performing various research studies along the way and publishing dozens of medical papers. But when he was born half a century earlier, this scenario would never have been possible.
The Progressive Era: Rapid change for society and medicine
Louis Tompkins Wright was born July 23, 1891, in LaGrange, Georgia. At that time, Wright’s father, Ceah Ketchan Wright, was one of a handful of African American physicians in the nation. The elder Wright died soon after Louis’ birth, but the child’s mother, Lula Tompkins, married another doctor, Yale medical school graduate William Fletcher Penn. Growing up, Wright saw his stepfather remain committed to medical practice despite overt discrimination and also saw medicine and surgery go through extremely rapid advances.
The Progressive Era of United States history ran roughly from the 1890s to the early 1920s and was a time of unprecedented social and technological change. Homes became wired with electricity and telephone lines, the automobile was made available to the masses, and a plethora of machines made housework faster, while the phonograph, radio, and movies provided affordable entertainment and helped to connect people in distant lands. Technology also took off in the world of medicine while doctors and scientists identified numerous viral and bacterial agents that caused most of the death and suffering for people in that period. This was the time when the X-ray machine was introduced and when physicians figured out that people had different blood types, so that finally they could transfuse blood without causing a fatal reaction. (Read about the breakthrough research that led to safe blood transfusions in our module Blood Biology I: Components of Blood.)
When Wright was born, ideas that are basic to modern surgery – ideas such as clamping and sewing each artery, aseptic technique (keeping the surgical wound and surgeons’ hands extremely clean to prevent bacterial infection), and preserving blood supply to tissues that are not removed during an operation – were brand new. But by the time Wright was a member of the Clark Atlanta University Class of 1911, and especially by the time he graduated from Harvard Medical School in 1915 (Figure 2), surgery had entered a new age. Knowledge of how to prevent infection and blood loss, the ability to replace lost blood, new anesthetics, and a revolution in surgical instrumentation enabled the invention of hundreds of new operations that would have been impossible just a generation earlier.
Wright’s family was respected in the African American community and by many people of the white community. Consequently, Wright went through much of his childhood without witnessing racial tensions, but this started to change when he was 15 in 1907. In that year, blacks in and around Atlanta were victims of a race riot. Wright was accepted as the only black student in Harvard Medical School because he was a top student in college and because his stepfather was a physician of some influence, but once at Harvard, Wright was not treated like everyone else. There were occasional remarks and racial slights, and things worsened when it was time for Wright’s clerkship in obstetrics and gynecology (Ob/Gyn). All other students were assigned to an Ob/Gyn ward of an upscale Boston hospital for work, but Wright was told that he must work with an African American gynecologist in a segregated private practice. Right refused and pointed out that he paid the same tuition as his fellow students and thus should train in the same hospital. His fellow students agreed with him. Many of them stated so to the school administration, and Wright was allowed into the normal Ob/Gyn clerkship.
Having earned cum laude honors, Wright should have marched near the front of the line of students at graduation, but he was ordered to walk at the end of the line. This was insulting, but then it was time to apply to internships and none of the top programs in the country would accept him despite his qualifications. His best internship option was Freedmen’s Hospital, a segregated hospital in Washington, DC. After training there for two years, he entered the Army Medical Corps when the US entered World War I in 1917. He wasn’t drafted, but joined to demonstrate that an African American could practice medicine in critical, emergency settings. He was commissioned as a first lieutenant and assigned to an infantry regiment in France.
This was an era when specialties were just emerging within medicine. Budding doctors at the dawn of the century could expect to perform surgery in general practice. However, the number of new surgical procedures introduced each year was so high and sophistication of the techniques so great that by 1917 operations could be performed successfully only by those practicing surgery exclusively and acquiring specific surgical training.
Punto de Comprensión
In spite of much racism in society at the time, Wright was treated like all the other students at Harvard Medical School.
A pioneer in medical techniques: Lessons from the battlefield
Surgeons learned quickly during the war. They were the first to acquire new techniques, which were forced upon them, and after the war they were the ones to bring the new techniques to their colleagues back home. To learn all that he could and to place himself at the forefront of surgery of his era, Wright eagerly accepted difficult cases and increasing responsibility. This set him up to be a pioneer in an area of surgery that was bound to advance during wartime: abdominal surgery related to trauma. Wright noticed that one organ, the spleen, was particularly vulnerable to injury. The spleen could be injured even if it did not receive a direct wound, but instead succumbed to forces of blunt trauma to the body. Thus, in addition to learning and adding his own innovations to the particular technique of removing an injured spleen (which often was needed to prevent a soldier from bleeding to death), he started thinking deeply about the phenomenon of injured spleens and taking note of the number of injuries.
Being at the front lines in World War I was immensely dangerous, and Wright became a victim of a German chemical weapon, phosgene gas (COCl2). It damaged his lungs irreversibly, making him vulnerable to health problems for the rest of this life, but he did recover enough to return to duty after three weeks. For being wounded he received the Purple Heart, and for his expanding surgical skills he was placed in charge of a surgical ward at a triage hospital, where he was trained both in new surgical procedures and in hospital administration. During this part of his career, Wright also introduced a new technique for vaccination against smallpox, called intradermal vaccination, because it involved injecting the vaccine into the deep layer of the skin. This was less invasive than previous techniques that penetrated beneath the skin. Thus, it was less likely to cause infections and other complications at the injection site (see Figure 4 for an example of this injection).
Wright returned to the US in 1919 only to find racial tensions particularly bad in Georgia. Prior to joining the Army, he had noticed discrimination connected with competition between blacks and whites in the workforce, and this led him to join a new organization, the National Association for the Advancement of Colored People (NAACP). Years later he would become one of the organization’s leaders, but for working in medicine or against discrimination, Georgia would not be the place to make his mark.
Like hundreds of thousands of African Americans of the period leaving behind the Jim Crow South, Wright relocated to the North when he accepted the clinical assistant position at Harlem Hospital. However, for hiring Wright, hospital superintendent Dr. Casmo D. O’Neil was forced out of his job. This knowledge only strengthened Wright’s resolve to excel, and excel he did. His wartime experience both in trauma surgery and administration made him an asset to the hospital. Gradually at first, and then increasingly, he was invited into the operating theater to put that experience to use. Here he earned a reputation particularly in management of head injuries and bone fractures.
Some of his studies were published as chapters with other authors in a textbook called The Treatment of Fractures and involved the clinical application of bone-healing hardware of Wright’s own invention. One of those inventions was a type of metal plate that Wright developed to support long bones of the legs to allow fractures to heal. He also described a new brace, also of his design and wrote about treating trauma to the skull and brain; this research consisted largely of trials of various diagnostic and treatment techniques in injured patients.
Like other leading surgeons of the period, Wright’s research was extremely broad and also included abdominal surgery. This was an area that was advancing rapidly during the Progressive Era, and it got an enormous boost during World War I. Stemming from his war experience with spleen injuries, Wright combed Harlem Hospital records of nearly 20,000 trauma cases from 1905 into the 1930s, including many which he had personally diagnosed and treated. He undertook an analysis with another surgeon, Aaron Prigot, and found that the spleen was involved in up to one-third of abdominal trauma cases. In 1939, Wright and Prigot published the findings as a detailed report in the journal Archives of Surgery. This led surgeons at prominent medical centers throughout the world to place emphasis on new spleen-focused, or splenic, procedures.
Punto de Comprensión
During World War I, Wright
A prolific researcher faces an uphill battle for publication
Getting his results published was no easy task during Wright’s early years at Harlem Hospital. He was a Harvard Medical School graduate at the forefront in the surgical world, yet Wright faced potential rejection of his papers from leading medical journals because of his race.
Near the end of his internship at Freedmen’s Hospital in 1917, he had gotten published as a first author in the prestigious Journal of Infectious Disease. That had been unusual for an African American, but the topic of the research related directly to his race. Specifically, the study involved a test for diphtheria called the Schick Test. In this test, a tiny amount of diphtheria toxin was injected into the skin of a patient’s arm. The skin around the injection would swell and turn red for a few days in any person lacking immunity to diphtheria. But little or no swelling would occur in a patient who made antibodies against diphtheria because of prior exposure to the bacterium that caused the disease (called Corynebacterium diphtheria, see Figure 5) or because of fortuitous natural immunity. The testing sounds straightforward, but since it had been developed for use in white children, an essay written by a researcher shortly after the Schick Test came into wide use had questioned the utility of the test in African Americans. The researcher believed that the dark skin color of African Americans might make it difficult or impossible to tell the difference between a positive and a negative reaction. After reading the essay as an intern at the Freedmen’s Hospital, Wright became interested in the topic, and this led to his 1917 study. Along with disproving the idea that the Schick Test might not work in African Americans, Wright’s paper was also the first study from Freedmen’s Hospital to be published in any medical journal.
Although it was an enormous achievement for any intern to get published, getting published back then had been a fluke for Wright. Despite his early journal success, Wright found obstacles to publication at Harlem Hospital after the war and on through the 1920s, depending on who happened to be assigned to review the submitted manuscripts. (Read about the process of proper, unbiased peer review in our module Peer Review in Scientific Publishing.) Sometimes reviewers were fair and judged the paper based on its own merit, but other times reviewers were simply racist. To overcome this obstacle, Wright sometimes needed to make himself second or third author with a white colleague as lead author, even on studies that he conceived and led. Only after building up a publication record over several years was he able to list himself as lead author as he deserved at times.
In addition to researching head injuries and bone fractures, as he had done during the war and during his training at Freedmen’s Hospital, Wright ventured into non-surgical research. He was drawn particularly to the clinical testing of two classes of new drugs. One class was antibiotics, especially a drug called chlortetracycline. The other class was drugs against cancer. Testing these drugs really lay in the realm of internal medicine, but they were relevant to surgery. Despite thorough washing of instruments and hands and the advent of surgical gloves, the emergence of antibiotics further decreased the risk of infection that could render any operation counterproductive. Surgery was and still is a major strategy for removing malignant tumors from the body, but not all tumors are operable (able to be removed without unacceptable damage). However, by treating a patient with an anti-cancer drug prior to surgery, the mass of a tumor can be reduced; the tumor shrinks and in many cases this can change an inoperable tumor into an operable one.
Punto de Comprensión
Wright showed that the Schick Test for diphtheria
Fighting against segregated medicine
In 1926, when Harlem Hospital hired three more African American physicians, Wright was promoted, and the promotions continued on through the 30s. (See an image of Dr. Wright making rounds at Harlem Hospital in Figure 6.) In 1929, alongside his Harlem Hospital appointment, Wright was added to the New York City Police Department as its first African American police surgeon.
Harlem Hospital treated the predominantly African American population that lived in the vicinity, but it was a public institution whose mission was to provide care for any US citizen, so there was also a substantial fraction of white patients. The hospital, run by white administrators in a time when racism was overt, developed a reputation for favoring white patients. This was a time when corruption was rampant throughout New York City institutions right up to the Tammany Hall politicians that controlled the city and even the state. Up through the 1920s, some white medical and administrative staff were openly hostile to black patients and allowed them to receive inadequate care, while more time with physicians and better care was allotted to white patients.
Wright became friends with the city’s Civil Service Commissioner Ferdinand Morton and, being trained in efficient military administration, made the case that corruption and inefficiency went hand in hand. He convinced Morton to begin an overhaul of Harlem Hospital and the entire city hospital system. Various corrupt officials put up roadblocks so that removing hospital corruption would be an expensive undertaking, but Wright worked with the NAACP to obtain a Carnegie Foundation grant. This financed a review of administrative and medical personnel as well as the publication of a book in 1936 that helped direct African American medical graduates into the city hospital system and also exposed the corruption. The resulting major reform throughout city hospitals dovetailed with the efforts of Governor (and later President) Franklin D. Roosevelt and Mayor Fiorello La Guardia to clean up Tammany Hall.
During the 1920s, Wright also founded an African American professional organization known as the North Harlem Medical, Dental, and Pharmaceutical Society, but he left the group in 1930 convinced that its members were not fighting against segregation. He was committed to ending segregated medicine and formed a new group, the Manhattan Central Medical Society. This group spent the first half of the 1930s preventing a philanthropic organization, the Rosenwald Foundation, from funding the establishment of a new all-black medical school and hospital that might have become a New York version of the Freedmen’s Hospital. Rather than training new black physicians in segregated settings, Wright was adamant that more blacks had to be admitted to study alongside everyone else. His efforts in this area made him fairly visible in the civil rights movement, and in 1934 Wright was appointed as chair of the NAACP board of directors.
First African American Chief of Surgery
Wright held his NAACP chairmanship for the rest of his life while continuing to practice surgery on the staff of Harlem Hospital. Throughout the 1930s, his rank in the Surgery Department increased and he continued to publish papers on clinical research; in fact, over his career he published 91 papers, 35 of them on the topic of antibiotics alone. In 1939, however, he developed tuberculosis and spent the next three years in convalescence upstate in the city of Ithaca. He was weak from the phosgene exposure during World War I and never fully recovered, but during that time he received the prestigious NAACP Spingarn Medal.
Wright finally returned to Harlem Hospital in 1942 and was appointed Chief of Surgery the following year with a limited schedule because of his health. (See Figure 7 for a lasting memorial of Dr. Wright at Harlem Hospital.) In 1948, he was elected president of the hospital board, and a few months before his death in 1952 the hospital inaugurated the Louis T. Wright Medical Library at an elaborate dinner with former first lady Eleanor Roosevelt as the keynote speaker.
In the first two decades of the 20th century, job opportunities for African American physicians were pretty much limited to black hospitals and segregated private practice. This module profiles Louis Wright, who in 1920 was the first African American physician to join the staff of Harlem Hospital and who ultimately became Chief of Surgery. The module traces Wright's life and career, from being the only black student at Harvard Medical School to pioneering surgical techniques on the battlefields of World War I. Readers will see how Wright broke racial barriers in many different areas of medical treatment and research.