The corporeal and ocular veil: Dr. Matilda A. Evans (1872-1935) and the complexity of southern history.

After the Egyptian and Indian, the Greek and Roman, the Teuton and Mongolian, the Negro is a sort of seventh son, born with a veil, and gifted with second-sight in this American world,--a world which yields him no true self-consciousness, but only lets him see himself through the revelation of the other world. It is a peculiar sensation, this double-consciousness, this sense of always looking at one's self through the eyes of others, of measuring one's soul by the tape of a world that looks on in amused contempt and pity. One ever feels his two-ness,--an American, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose dogged strength alone keeps it from being torn asunder.

W. E. B. Du Bois (1903)

IN THIS ESSAY I EXPLORE THE CONNECTION BETWEEN A SINGULAR BLACK woman medical professional, Matilda A. Evans (1872-1935) of Columbia, South Carolina, and the rise of health-care activism in the decades prior to the modern civil rights movement. The interests of the professional class and the needs of black people conjoined at critical historical moments. This case study of Dr. Evans's life and career deepens the understanding required to assess historian Carter G. Woodson's positive appraisal of the relationship between black professionals and the struggles of African Americans first for survival and then for equality of opportunity. The two-ness concept embedded in historian W. E. B. Du Bois's veil metaphor captures the complexity of living and surviving in a society that refused either to see black people's humanity or to accord them full citizenship rights as members of the body politic. (1)

After receiving her medical degree in 1897 from the Woman's Medical College in Philadelphia, Dr. Evans practiced medicine in Columbia for over three decades. She specialized in the fields of surgery, obstetrics, gynecology, pediatrics, and hygienics and developed an interracial clientele. But her paramount concern was for the health and educational welfare of black children, who, in her opinion, represented the soul and hope for a better future for "suffering humanity." An indefatigable institution-builder and a master of the art of professional self-promotion, Dr. Evans established two hospitals and a nursing training school at the dawn of the twentieth century. In 1916 Evans began ardently advocating better health-care delivery and criticizing capitalist exploitation of black laborers. This transitional moment in her career is marked by, among other things, publication of her biography of Martha Schofield, a white Quaker educator and the founder of the Normal and Industrial School at Aiken. In this year Evans also created the Negro Health Association of South Carolina (a public-health visiting nurses operation) and edited its official organ, the Negro Health Journal.

As the health status of black Columbians steadily deteriorated, Evans became even more convinced that health care was a citizenship right every bit as important a responsibility of the state as was public school education. In 1930 a reporter for the Columbia Palmetto Leader wrote of Evans, "She has ever claimed, and now contends, that free clinics ought to be as much a public concern and provision as are public schools." (2) Thus, at the outset of the Great Depression, Evans launched a free-clinic movement and inspired the black community in Columbia to demand health-care citizenship rights even as the state became less inclined to adopt any progressive reforms that improved the material conditions of black lives. In the opinion of Jane Van De Vrede, division director for the Red Cross, "the great number of negroes [sic] forming a dependent population which must be carried outright in any welfare undertaking" was a powerful disincentive for white South Carolinians to adopt any progressive health-care programs. (3)

A close reading of Evans's biography of Martha Schofield provides a glimpse into Evans's inner life that helps us to understand the ideological underpinnings of her activism for social change. Evans uses Schofield like a ventriloquist. In the pages of this book, Evans deftly commandeers a public space in which to express ideas and to deliver opinions that may have jeopardized her relations with both conservative and liberal white colleagues and benefactors had she explicitly claimed them. For example, her study probes the advantages of calling on the federal government to create an all-black state somewhere in the West as a strategy to protect black people from the ravages of white terrorism. In this ostensible biography Evans articulates many provocative views, craftily attributing them to Schofield. (4)

To be sure, Schofield may indeed have fantasized about a "Negroland," but Evans was a black professional woman whose reality was shaped by the racial politics and customs in South Carolina. Evans, as did Schofield, identified strongly with the poor black victims of white terrorism and oppression, and both women bore a deep sense of moral and professional responsibility for blacks' survival. Surely Evans's reality underlined philosophical yearnings to escape but dictated that the wisest course to follow was to work in her native state. Thus, she went to work. She developed the resources, both material and social, that were essential to waging a successful struggle for black survival. She did this without betraying a hint of alienation and anger, at least in public. Across the three decades of her practice Evans bided her time as she cultivated an unsurpassed professional reputation. She earned the distinction of being the only black woman physician in the country to serve a term as the president of a state medical association, the Palmetto Medical Association, and was one of the regional vice presidents of the National Medical Association. By the 1930s the black community in Columbia expressed considerable reverence for Dr. Evans. Indeed, an article in the local newspaper the Palmetto Leader referred to her as "the dean of Negro physicians in South Carolina." (5) In many ways, she was a leader in Columbia's black professional community much like the nationally acclaimed South Carolinian Mary McLeod Bethune, who became a major anchor in the so-called Black Cabinet of advisors on Negro affairs that came into existence in the late 1930s during President Franklin D. Roosevelt's administration. (6)

Evans's professional negotiations and both her private and public struggles to prosper, at once within and outside the veil, make her life an ideal medium through which to illuminate and to unravel some of the complexities of southern history. She worked closely with leaders in both the white and black communities. Evans offered white Carolinians insight into the effects of poverty and dire health conditions among the black people who worked in white homes as they simultaneously struggled to exist within the veil. Concomitantly, through lectures and her own example, Evans helped to inspire and strengthen black resolve to force white citizens of the Palmetto State to treat African Americans as vital members of the body politic, their physical bodies deserving of care and respect. (7) Evans preached and lived the gospel of providing service to the people in ways that allowed them to help themselves. She believed that "one person can do but little within herself for the benefit of the people, but by securing their cooperation to the extent of getting them to practice as a whole and teach in unity the things most needed to be taught, results of the most far reaching consequences could be achieved." (8)

My fascination with Dr. Matilda A. Evans grows out of my larger interests in the development of the black professional class (specifically physicians, nurses, and lawyers) and the history of black women during the era of white separatism and Jim Crow discrimination. (9) Although an unknown figure outside her native South Carolina, Evans belongs in the company of her generation's most notable black women activists in and beyond the South, including Ida B. Wells-Barnett, Anna Julia Cooper, Maggie Lena Walker, Madam C. J. Walker, Mary McLeod Bethune, Mary Church Terrell, Lugenia Burns Hope, and Nannie Helen Burroughs. (10) Beginning in the 1890s, a period that historian Rayford W. Logan refers to as "the nadir" because of the deplorable state of race relations, the black community produced a class of professional men and women who would meet the race's survival needs, promote its uplift, develop its advancement agenda, and provide a crucial link with the struggles of the mid-twentieth century for first-class citizenship. (11)

I use three concepts--white separatism, black parallelism, and equality of opportunity--to capture the development of black professionals and the roles they played individually and collectively to engineer social reform from the Progressive era through the crises of the New Deal and World War II. (12) Historian Leon F. Litwack's description of Jim Crow conveys some of what I mean by "white separatism." He argues that beginning in the 1890s "What the white South did was to segregate the races by law and enforced custom in practically every conceivable situation in which whites and blacks might come into social contact.... Not only were the races to be kept apart in hospitals (including a special section for black infants requiting medical attention), but some denied admission to blacks altogether. Laws or custom also required that black and white nurses tend only the sick of their own race." (13) Rayford Logan offers insight into the potential radical implications of the resistance strategy and ideology that I refer to as "black parallelism." He suggests that "the doctrine of 'separate but equal' first sanctioned by the United States Supreme Court in Plessy v. Ferguson, 1896, was a 'radical' concept. But, perhaps unwittingly, Negroes continued to use segregation as a weapon to remove segregation." (14)

In other words, given white southerners' grim determination to separate themselves and their institutions from black people, the latter were forced to pursue a strategy of parallel institutional development. Specifically, black men and women had to create an array of separate, blacks-only organizations, schools, and facilities in the health-care arena as the grip of legally sanctioned discrimination and disfranchisement tightened. Thus, over the course of four decades black men and women created their own social welfare state within the veil. As historian Cynthia Neverdon-Morton posits, "The Progressive Movement ... helped to bring about needed reform and a restructuring of white society. Afro-Americans, however, were generally excluded from ... the effort to change the American social order. Consequently, Afro-Americans had to create their own social service organizations to aid the victims of an oppressive society." (15)

In 1895 a group of black physicians met in Atlanta to found the National Medical Association. (16) Just as the American Medical Association denied membership to nearly all African Americans, so too did the American Nurses Association. Accordingly, in 1908 a group of black nurses launched the National Association of Colored Graduate Nurses. Black physicians, nurses, and civic, secular, and business leaders cooperated in the establishment of a national network of institutions that included state and local professional associations, clinics, sanatoriums, community centers, and nurse training schools. (17) Virtually every black urban community in the South possessed an array of advancement organizations, newspapers, fraternal and mutual aid societies, women's club auxiliaries, social welfare agencies, and educational institutions around which cohorts of professionals joined forces with prominent civic and religious leaders. Collectively, black professionals cemented support for multifaceted socioeconomic and political agendas, grounded in self-interest and fueled by the imperative to forge class and gender solidarity within the race. (18)

On Wednesday, April 24, 1907, for example, at the twelfth annual meeting of the Palmetto Medical Association, South Carolina's black physicians issued an appeal for donations to facilitate the work of the hospital training school of Charleston. While the chronically strapped institution needed every penny it could get, the $6.10 collected for the city's lone black health-care institution possessed greater symbolic significance than monetary value. (19) On the next evening, Charleston Hospital and Nurse Training School founder Dr. Alonzo C. McClennan, who was also elected incoming president of the Palmetto Medical Association, and a physician colleague Dr. C. H. S. Henderson delivered addresses entitled "The Modern Hospital" and "The Physician and his duty to the body politic," respectively. (20) The establishment and maintenance of these health-care facilities and the organizations that sustained them were essential to the development of a distinct professional consciousness. As one newspaper editor put it, "[M]ost white [medical] practitioners just are not interested in whether Negroes live or die." (21) Public hospitals across the South denied black physicians staff appointments and visiting privileges. Many African American doctors, therefore, opened proprietary institutions in order to have places in which to attend their own patients with dignity and, of course, to generate income. (22)

In 1910 Abraham Flexner reported to the Carnegie Foundation on the quality of medical education, and the American Medical Association supported the report's recommendations for reform. Following the aftershocks of Flexner's findings, only two black medical schools remained standing out of the dozen that had been founded in the last third of the nineteenth century. For the next half century these two schools, Howard University College of Medicine in Washington, D.C., and Meharry Medical College in Nashville, Tennessee, trained close to 90 percent of all black physicians. (23) One of the score of female medical colleges to remain viable after the reform impulse subsided was the Woman's Medical College of Pennsylvania. It produced a small but significant cadre of black women physicians who fashioned distinguished careers in several southern states. (24)

Approximately 250 black hospitals and training schools for nurses produced the vast majority of black women nurses. The first four black nursing schools founded in this era of white separatism and black parallelism were Dixie Hospital at Hampton Institute in Virginia, John A. Andrew Memorial Hospital at Tuskegee Institute in Alabama, MacVicar Hospital at Spelman Seminary in Atlanta, Georgia, and Provident Hospital in Chicago, Illinois. (25) Establishment of the hospitals followed the opening of the nursing schools in order to provide practice opportunities for nurses, as well as health care to adjacent black communities. (26) Among the largest and most respected urban hospital centers were Chicago's Provident and New York City's Lincoln Hospitals. Beginning in the 1930s some leaders among black nurses spearheaded a successful movement to place the study of nursing into the curriculum of southern black colleges and universities. (27)

Several questions frame my effort to discern the levels of meanings that the life and career of Matilda Evans exemplify. What was she really saying when she set out to persuade the State Board of Health of South Carolina to give her free vaccines with which to immunize black schoolchildren in Columbia? What did she mean to convey when she founded Taylor Lane Hospital and allowed only white doctors to attend black patients in the facility? How do we know her reality as she experienced it? How do we explore the resistance strategies she pursued while trying to improve the quality of life for thousands of dispossessed, disfranchised, economically exploited, and racially oppressed citizens? Given the artful use of dissemblance by black women who juggled multiple agendas as they guarded their private lives and inner thoughts from intense white scrutiny, how is it possible for scholars to penetrate their interiority? By all accounts, Matilda A. Evans was a brilliant black woman professional who effectively negotiated on behalf of her people and herself in severely restricted racial, sexual, and class-defined space. (28) How was she able to accomplish so much that was beneficial and inspiring in a period dominated by racial violence, hatred, and legally sanctioned segregation?

Matilda Arabelle Evans--the eldest of three children of Anderson and Harriet Evans--was born in 1872 in Aiken County, South Carolina. (29) She came of age during the tumultuous post-Reconstruction era of racial violence, economic exploitation, and the entrenchment of a system of black disfranchisement and white separatism. The New South held few opportunities for social-class mobility, higher education, and professional careers for black women. (30) As Booker T. Washington declared in his 1895 address at the Atlanta Cotton States and International Exposition, wise black people in the South understood that "the agitation of questions of social equality [was] the extremest folly." He advised blacks to exchange protest for a strategy of "severe constant struggle" to achieve self-improvement and racial uplift. His advice described Evans's early years. But Evans was more fortunate than the majority of her sisters. She was one of the few desperately poor black women who managed to escape lifelong consignment to domestic drudgery and agricultural peonage. (31)

Evans's severe and constant struggle bore a different fruit. Indeed, Evans's industriousness as a young girl attracted the attention of Martha Schofield (1839-1916), a Quaker from Philadelphia who would become her mentor and benefactor. Understandably, Evans revered Schofield as a saint whose fortitude and courage she emulated and whose values she internalized. According to Evans, Schofield "bore the poison sting of slander, the cruel whip of character assassination and braved the threat of personal violence" while making "personal sacrifices" to educate black people. Evans asserted that Schofield's accomplishments (particularly the creation with northern financial assistance in the late 1860s and early 1870s of the Normal and Industrial School at Aiken) "form a tribute to the efficiency of women ... that is seldom ever equaled by other human beings claiming greater strength by reason of sex." Evans confessed that she "shall never forget but she will always remember and value ... the heart of her who had the heroic courage and the splendid manhood [sic] to risk her life in the unselfish and holy cause of implanting in the Negro mind and soul that which is beautiful, noble and sentimental." (32)

Schofield, whose motto according to Evans was "'Thoroughness,' thoroughness not only in books and the industrial arts, but in thought and action as well," gave to Evans an opportunity she would treasure forever. Young Evans, as was expected of all students, worked in the school's gardens and cotton fields. Schofield, impressed by the young girl's diligence and intelligence, helped Matilda secure funds to attend Oberlin College in Ohio. Before she graduated, in 1892 Matilda left Oberlin to assume a one-year teaching position at Haines Institute, founded by Lucy Laney in Augusta, Georgia. In 1893 she returned to Aiken to assist Schofield. Evans then decided to pursue medical training. (33) Martha Schofield once again intervened, this time to facilitate Matilda's entry into Woman's Medical College in Philadelphia, where white benefactor Alfred Jones contributed to her expenses. By 1900 the Woman's Medical College had graduated approximately a dozen black women physicians, four of whom became the first of their race and sex to practice in southern states that included Alabama, Mississippi, and South Carolina. (34)

Ten years after earning her degree, Evans contacted Jones to ask him to support another black woman, Melissa Thompson, who had completed the nursing training program in Evans's proprietary hospital. She prefaced this request with a description of her own success thus far. She wrote, "You may remember me as being the colored student to whom you gave a scholarship in 1893 to The Woman's Medical College of Penn. I graduated in the class of 1897 and came South and have built up, as I must tell you, a most enviable reputation. I have done well and have a very large practice among all classes of people. I have not lost one day, since I left College." (35) Evans took special pride in the fact that so many affluent white women sought her services. This warrants elaboration.

Dr. Evans's practice among white women of means probably, and here I am speculating in the absence of patient files and other manuscript sources, involved treatment for their problems related to sexuality. A specialist in surgery, obstetrics, and gynecology, Evans was able to treat women patients who had medical problems that they did not wish to become known among the members of their social circles. Such problems may have included sexually transmitted diseases, injuries resulting from domestic abuse, and pregnancy regulation, Of course, many may have simply preferred a female health-care provider. Both black and white women benefited from her practice. Wealthy white women found safe space in this black woman's medical practice. Their patronage not only provided Dr. Evans much-needed income but also imparted a measure of protection and prestige to the middle-aged professional. She, in turn, repaid them with her expertise and discretion. With the money they paid her, Evans was able to treat black women and children free of charge. Evans's professional benevolence to black people not only saved lives but heightened their respect for her authority, ability, and autonomy. This was no small accomplishment in turn-of-the-century South Carolina. Her successful negotiations across boundaries of white and black, rich and poor, men and women, professionals and laity were essential to the effectiveness of the advocacy for social reform that characterized the second half of her career.

Evans had few black or female role models to emulate as she blazed Jones, "It seems when I came to Columbia that the harvest was ready and waiting for me. The obstacles I did not consider very much and I have had unlimited Success." (36) Although Evans claimed the distinction of being "the first woman physician to hang out a shingle in this state," an earlier black graduate of Woman's Medical College, Lucy Hughes Brown, had opened practice in Charleston, South Carolina, a few months before Evans. (37) There were nearly a half-dozen black male physicians in the state. The percentage of women among black physicians in South Carolina was more favorable than nationwide. In 1920 there were 3,855 black physicians in the United States, less than half a percent of whom were women. (38) In 1900 none of the 7,000 white women physicians in America practiced in South Carolina. According to historian James D. Anderson, in 1900 there were approximately ten million black people, yet the "ratio of black physicians to the total black population was 1 to 3,194 compared to 1 to 553 among whites." (39) Given the small number of black women in the profession and the prevalent hostility toward women who entered this overwhelmingly male occupational sphere, Evans deserves notice for her term as president of the all-black Palmetto Medical Association in 1922. (40) Perhaps observing a physician with similar goals, Evans admired the qualities she saw in the first white woman doctor who eventually settled in Columbia, Dr. Jane Bruce Guignard (also a graduate of the Woman's Medical College). According to Evans, Dr. Guignard was one "whose soul is in the work of caring for and helping suffering humanity." (41)

From the outset, concepts of soul, caring, racial uplift, and alleviation of suffering shaped Evans's evangelical understanding of her medical missionary stewardship and sense of calling in Jim Crow South Carolina. Although the records of their thought are scant and scattered, she and other pioneering black medical women shared progressive views about the importance of feminine autonomy, authority, and dignity. These were essential prerequisites for achieving social reform, status mobility, and racial advancement. When Dr. Evans opened her practice in Columbia, a small black professional class was already taking shape. The city boasted three black lawyers, two black male physicians--Drs. C. C. Johnson and C. J. Walton--and a pharmacist, Dr. James J. Leggett. (42)

Within a few years of setting up medical practice in Columbia, Evans had impressed her white medical colleagues and the white business leadership in the city to the extent that the Columbia State, the leading white newspaper, published en account of her work under a laudatory headline designating Evans "South Carolina's Brainiest Negro." The subtitle exulted, "Dr. Matilda A. Evans, a Black Woman, Who Has Saved Hundreds of Lives and Has Educated Many Trained Nurses." The magazine-length article described her institution-building work as the founder of the Taylor Lane Hospital and Training School for Nurses in 1901. Prior to opening the hospital Evans treated patients in her home or made house calls. Later, after a fire destroyed the Taylor Lane Hospital, Evans created a fourteen-room, twenty-bed hospital facility, St. Luke's Hospital and Training School for Nurses, that she operated until 1918. Furthermore, she founded the Negro Health Association of South Carolina to promote sound health practices and preach the gospel of sanitation to black citizens. (43)

The author of a reverential profile of prominent South Carolina Negroes referred to Matilda Evans as "an apostle of sanitation and better living conditions.... She is a preacher of harmonious, helpful relationship between the races." He elaborated, "Frankly cordial and affable, she is self-reliant, efficient and constructive. One is impressed that she does not waste time kicking about untoward conditions, but sets about righting them." (44) Of all the adjectives used to describe Evans, the one that she preferred was "efficient." She recalled how this quality was one that Schofield had nurtured in her students. "The success which attended the efforts of the graduates of this School is due, in the main, to the strict regard for efficiency with which this great woman inspired every student coming under her influence." (45)

The State newspaper article included earnest testimonials from "the best [white] men in the profession," who praised Evans's "ability as a surgeon and a physician." One white physician also declared elsewhere that "nurses that are turned out from the training school are sought after by the doctors and the better class of people of our city." (46) Needless to say, the article in the State did not indicate that these nurses were more likely to work for less money than did their white counterparts. Rather, the article concentrated on the apparently positive and universal white approval of Evans: "As for Dr. Matilda Evans, her devotion to her work and her earnest Christian character are both unquestioned." The black community shared an equally high estimation of Evans's worth. According to one writer in the black community's newspaper, the Palmetto Leader, "The State of South Carolina has not produced, within our group, a citizen more meritoriously outstanding." This newspaperman asserted that Evans's most "pertinent" characteristics were her "human.... artistic, spirit" and "the consuming zeal to render service rather than to accumulate money or to acquire popularity." The black journalist approvingly concluded that a spirit of service and altruism "truly dignified ... her professional career in our midst." (47)

Black professional women walked tightropes above the chasms of race and gender. Both black and white communities shared similar expectations. A black woman physician had to display her "Christian character" and prove her professional ability, all the while remaining feminine. Prevailing negative stereotypes of black women as deceitful and morally and mentally deficient dictated that Evans weave nuanced performances of competence, respectability, and religious righteousness seamlessly into public career and private life. Historian Evelyn Brooks Higginbotham maintains that black women "often explicitly deployed manners and morals to challenge charges of black immorality." Good manners and morals were also "tools for winning sympathetic white allies." (48) How well Evans integrated demonstrations of "earnest Christian character" with professional competence and displayed good manners and morals determined the fate of her parallel health-care institutions and organizations. The survival of the most vulnerable people in the black community depended to a degree upon Evans's acquisition of white recognition and black cooperation. The tenuousness of her position requires more exploration.

From the start, Evans simultaneously had to prove her professional competence and to practice the politics of respectability by becoming a paragon of feminine virtue. As her contemporary, Brooklyn educator Maritcha R. Lyons, made clear, "the fear of woman unsexing herself was the bugbear" of the era that witnessed the emergence of the black woman physician. The life and work of Susan Maria Smith McKinney Steward (New York Medical College for Women, class of 1870) illustrate the difficulties that a black woman professional encountered in Victorian America. In writing about her friend Steward--the third black woman to earn a medical degree--Lyons declared that it took more courage for a black woman to pursue a medical career, given the depths of racial and sexual proscriptions, than it did for a man or a white woman to enter the profession. She advised that a woman embarking upon such a course should be "more alert, more progressive, more aggressive, [and] more ready to follow paths of upward trend." Lyons, however, took pains to delineate each of Steward's feminine attributes. She called her friend "a fine illustration of an exemplary matron, an admirable mother, a model home keeper, and a woman active in all matters pertaining to general uplift and betterment." (49) Steward, like Evans, would use religious affiliation to establish closer relationships within the black community.

Evans founded the first black-owned hospitals in Columbia at a time when the city's population exceeded twenty-five thousand, more than 40 percent of whom were black and therefore denied access to the city hospital. Evans reminisced about the founding years of the black hospital. "Our first and second years marked great progress. During the third year there were five hundred patients admitted to wards of the hospital and during the fourth year the number of patients was over six hundred." In order to keep the enterprise afloat, Evans drew upon five sources of financial and professional support. The student nurses, as was a commonly accepted arrangement in nursing, contributed their labor in the hospital in exchange for training and housing. Another practice, reminiscent of slavery and the apprentice system of an earlier era, was called "hiring out." Evans noted the success of the "hiring out" of her student nurses. "During the past few years the nurses have answered calls and they have turned into the institution whatever money they have made." Evans herself was the second major source of support. She provided medical services and made personal sacrifices. About her own contributions she wrote, "Seeing that the work of maintaining its growth and extending its usefulness needed more close attention and the watchful eye of one whose heart was in the work, I gave up my private practice and private sanatarium in the city. I moved to this institution and assumed the duties that should have fallen on the shoulders of a subordinate [meaning a Superintendent of Nurses]." (50) George Bunch, a white physician who served as a member of the operating staff of the Taylor Lane Hospital, testified to Evans's competence, perseverance, and sacrifice. Bunch wrote to potential benefactors, "She is a most capable woman and one with less perseverance and will would long ago have given up in despair of establishing a hospital for Negro patients in Columbia. Her efforts in behalf of such an institution have been untiring. For years she was unaided, running the Taylor Lane Hospital and Training School for nurses with money made in her private practice." (51)

The three remaining sources of support were white businessmen, white women clients who paid fees for Evans's services, and the volunteer services of young white physicians. About the latter group Evans observed, "We are grateful to several able physicians, all white, who have so willingly contributed their time and assistance at any hour, night or day, through storm, through sunshine to care for the afflicted poor of my people." She added that "recently several young physicians who have settled in our city have kindly consented to do the work of this Hospital free of charge." (52) Evans's uncritical account of the collaboration of white physicians who volunteered services to the Taylor Lane Hospital was undoubtedly calculated to ensure their continued support. Black medical men, however, interpreted the motives of white physicians in a less favorable light. W. Montague Cobb, a professor of anatomy at the Howard University College of Medicine, underscored the practical benefits white physicians derived from the experience of working in black hospitals:

   To many white physicians, particularly ambitious younger men, the
   Negro patient represents clinical experience. Such physicians have
   no love for the Negro, but they want to control the clinical
   material he represents so they try to keep control of the Negro
   wards, even of the most abominable character, in segregated
   hospitals, and also of voluntary or semi-private Negro hospitals.
   They thus get opportunity for all the surgery, with contract fees
   in many places, and are able to practice at a level at which they
   could not compete with a strictly white practice. These men do not
   welcome the advent of well-trained Negro physicians and use the
   stone wall of local custom as a "stall" to deny them hospital
   staff privileges. (53)

But if this unfeeling attitude of white doctors toward black patients had been the usual case in Columbia, it is doubtful that Evans would have allowed--much less sought--the services of white caregivers. One of the white attorneys in Columbia, John T. Duncan, underscored the unusual degree of cooperation between Evans and white male physicians. He wrote a fund-raising letter for the fledgling Taylor Lane Hospital declaring that Evans was "the best educated and most intelligent member of her race I have ever known." Duncan then noted that "all the white physicians of our city patronize her institution, sending their colored patients there and operating there also." He concluded with assurances that Evans had earned "the confidences of the community and the best wishes of the white people." (54) On the one hand, white association or affiliation with Evans and her hospital reflected the existence of a diversity of behaviors, if not attitudes, within the white elite. Such engagement underscores the existence of white liberals within a predominately conservative and racist social system. On the other hand, white altruism neither threatened white supremacy nor indicated a rejection of beliefs in the inherent inferiority of black people. Thus, in Cobb's analysis this form of white opportunism, to wit, free service in Evans's hospitals, may have actually preserved white separatism.

Evans also surely took pride in the assistance she received from white Columbians prominent outside the medical arena, and she assiduously cultivated their esteem. Indeed, Evans must have been a very persuasive woman to develop collaborative relationships with some of the state's larger employers of black workers. For example she negotiated agreements with the Southern, Seaboard Air Line, and Atlantic Coast Line railroads, the Electric Street Railway, and the Columbia Light and Power Company and Factories. These businesses, she recorded, "contracted with the institution to care for the employees and pay for each patient one dollar a day." (55) White physician William Weston, who served as surgeon of the A. A. L. Railway Company, harbored little doubt about the usefulness of Taylor Lane Hospital. He declared that "I do not know what would have become of the injured and ill colored people here and abouts had she not had this hospital whose doors have always been open whether the applicant had money or not." (56)

The second half of Evans's medical career, from 1916 to 1935, registered subtle shifts and significant changes in her public identity and posture. She founded health organizations, edited a journal, and wrote pamphlets. She established a community center, adopted seven children, and served as a foster parent for over two dozen more. All the while she continued active involvement in professional medical associations. (57) She eventually closed her hospital and nursing training school in 1918. Yet she opened a swimming pool "for undernourished and underprivileged boys, ranging from eight to sixteen years." (58) She drew closer to the black community while she continued to address the white community, perhaps trying to arouse determination in one group and compassion in the other. Thus, her writings open a window on the exploitation and second-class citizenship that black people endured.

While it is impossible to determine all of the factors that contributed to the transformation in the later stages of Evans's career, there were nevertheless several events that undoubtedly left a lasting impression. Most notable was the death in 1916 of her white mentor and benefactor, Martha Schofield. The previous year, 1915, had witnessed the death of Booker T. Washington. Perhaps the death of Schofield--the most significant person in her life--allowed Evans to express her own opinions about those issues that mattered most to her. For example, Evans felt compelled to contrast Schofield's and Washington's race leadership strategies and styles. Not surprisingly Schofield emerged as having been, in Evans's opinion, more worthy of emulation than Washington. She maintained that Schofield "went about securing the cooperation of the whites in a manner entirely different from the means employed by Booker T. Washington.... She drew attention of the white people to the necessity for her work by making them mad; by expressing to them the inconsistencies of their position on the race question and demonstrating to them the hypocrisy of their actions." Evans concluded that Schofield thus had "caused a great deal to be done for the Negroes that would have been delayed for years had more persuasive measures been taken to reach them." (59) In addition, an emerging militancy among black professionals and the intelligentsia intensified protest against the system of racial caste. The "New Negro" embraced a new mission and definition of leadership. By World War I, and certainly its aftermath, black leaders had determined that their role was "to represent the struggles and aspirations of black people and to articulate the very source of the masses' discomfort and oppression." (60)

In her biography of Schofield, Evans revealed her own intellectual moorings, wrapped in guarded optimism that change would come. She was writing at a critical conjuncture of growing black discontent and rising white aggression. She insisted that "[t]he majority of white people, as well as the ignorant, all speak out and say in 1916 what--they asserted in 1876--that God made them of better clay than He made colored people and that they will shoot Negroes and steal their votes from the ballot boxes just as long as murder and robbery may be necessary to maintain their hold on the government." Evans advanced several intellectual responses to white arrogance, one of which involved the establishment of a separate state called "Negroland." To be sure, she claimed that this was one of Martha Schofield's ideas. If so, then it is ironic that Schofield called for a space in which black people could demonstrate their capacity for self-government and live in freedom from white terrorism and negation of their humanity, even as she ignored that for most of its history the black-majority state of South Carolina was in fact demographically a Negroland. According to Evans, "Miss Schofield advocated for the colored people segregation in a state or territory of its own, in which only people of color or those as now defined by national authority as Negroes, might become citizens." Evans reasoned that this plan merited consideration because of "the continued persecution of the Negro on account of his color, and the growing resentment of the race at the open discrimination practiced by the whites of all sections." She concluded that "The whites of the South by and large and [sic] increasing majority make no pretense at the determination of that race to keep the Negro down politically, at least; they depend upon their ability to do this as the only means of continuing themselves in power." (61)

Evans doubted that black people would escape to "Negroland." Rather, whether from frustration or deeply embedded hope, they would one day soon "not only demand but force the constituted authorities to grant absolute equality in the administration of justice; when he shall not only demand the right to vote, to sit on juries and represent his country in its legislative deliberations and actions but shall force his rights in these premises." Still, she wavered and anticipated that "When the Negro demands a share in the affairs of the government as he inevitably will and most assuredly should do, then will come concrete examples which will not only justify the separation of the two peoples through some plan of segregation, but make their separation imperative." (62)

In September 1916 a headline in Evans's locally circulated Negro Health Journal ominously read "Cheap Living, Poverty, Disease and Death Lay Heavy Annual Tax on People Everywhere." In a lengthy essay Evans argued that "everyone rich and poor, white and black, employer and employee suffers from the prevailing low wages paid to Negroes." She was convinced that "[p]rivate families would profit by a higher wage scale by having cleaner healthier servants in their homes and more honest servants too." She made plain that "cheap help contaminate your home even the very food you eat because they can not be clean healthy and honest on the wages they get." Further, she asserted, "Cheap help carry off in course of time more than the difference between what they get for wages and what they ought to get and they have no conscience against 'taking' because they feel that they have not been treated right. This is sad. Stolen goods can profit no one." Evans concluded that "The employer is both a material and a spiritual loser for he has contributed to his employee's dishonesty [and] he is a partner with him in his sins." (63)

Evans emphasized the complicity of white employers in black people's resort to, as she termed it, "taking." (64) Both were guilty of disobeying God's commandment against stealing. In her reckoning, the theft of black people's labor was the original sin that led to subsequent black transgressions. Evans suggested many avenues of white atonement (without overtly labeling them as such). She proposed that, in addition to paying their workers fair and adequate wages, whites should also compensate for their contributions to black suffering by paying for a new visiting-nurse health program. Such a service would force the public to assume responsibility for the eradication of tuberculosis in black communities. She reiterated the then-popular refrain that germs abided no color line and that whatever ailed the black worker would make its way into the homes of whites, with resultant loss of income and funds. Evans explained the reasoning behind the proposal for a visiting health service: "Through the visitations of these nurses they [working poor black residents] will be instructed also in the matter of ventilation, sleeping[,] cooking and eating." There was one requirement: "With a few hundred dollars which is absolutely esseential [sic] to the success of our working we could prevent the communications of this disease to many whose time and potential earnings to society would exceed the cost of our services by hundreds of thousands of dollars." She added beseechingly, "Will not somebody help us immediately before it is everlastingly too late?" (65)

Evans's critique of the capitalist exploitation of black workers focused on domestic laborers and did not address the exploitation of industrial workers who, in keeping with racial stratification, were relegated to the most dangerous and least remunerative jobs (that is, when they were fortunate enough to get them). We can explain this silence in either of two ways. First, the majority of black workers in Columbia held domestic-service jobs and received so little pay that even white mill-workers could afford to hire them. (66) Second, white industrial leaders contributed to Evans's various hospitals and clinics. Her economic dependence on these businessmen may have hindered her denunciation of their exploitative and racist practices.

While Evans attacked economic exploitation as the cause of black debasement and poor health, disturbing voices of white separatism grew more strident. In South Carolina as elsewhere, advocates of eugenics appealed to white audiences with claims of scientific racism. They agitated for state policy to prevent racial contact and thus preserve the nation from "mongrelization." (67) Meanwhile, local and state governments turned deaf ears to black entreaties for sewers, adequate fresh water, paved streets, clinics, and sanitariums. The disproportionately high black mortality rates for tuberculosis and infant mortality in southern urban communities worsened. (68) By the 1930s, community activism dominated Evans's professional activities. She was determined to pressure the state to take responsibility for black health care. She called upon black religious leaders, arranged meetings with prominent black businessmen, and attended gatherings of well-regarded black clubwomen. On June 21, 1930, the Palmetto Leader reported that Evans organized separate meetings of men and women in her home "to help this sponsoring of a clinic in the city for our children." (69) She organized them into a Columbia Clinic Association that was composed of three clubs, one for women, another for men, and a third for girls. The clubs met in the basement of Zion Baptist Church and gradually developed a shared commitment to pressure the state to assume some responsibility for health care. Evans's orchestration of the free-clinic campaign bears out historian Charles M. Payne's observation that men led but women organized. (70)

Evans believed that "the health of a people is that people's wealth" and argued that "the ounce of prevention is better than a pound of cure." (71) Through a carefully executed plan that enlisted the support of diverse constituencies, Evans created a movement that the secretary of the State Board of Health deemed wise to accommodate. As Evans recalled the mobilization process, "We went from church to church and from school to school." She confided, "Before we were able to set up our work we had to educate people up to the idea of having such an institution." (72) According to her, the secretary of the State Board of Health promised vaccines, and the Richland County delegation made an appropriation of five hundred dollars to the Columbia Clinic Association to execute the experiment of establishing a temporary free clinic housed in the basement of the Zion Baptist Church. (73)

On the July day in 1930 that the clinic opened to provide free vaccinations, an overwhelming number of children and their parents and guardians stood in line. The Palmetto Leader heralded the effort, "The first day the Clinic was opened 700 came in for service[,] which showed that the people were anxious for the service and also the need of bigger and permanent headquarters." For three months the Palmetto Leader provided extensive coverage of the operation of the clinic and the efforts of black leaders to secure a permanent home and state allocations for it. (74) Evans lectured across Richland County and gave interviews to media. She declared, "I am determined--I have sworn it--that in whatever else our group in Columbia be negligent or indifferent, our children shall not be deprived of the advantages which a first class, most modern clinic can give." (75) By September the Palmetto Leader indicated that "Already 3187 have been examined as well as 1108 vaccinated. And a steady stream [o]f hundreds continues each day to come." In October 1930 the paper offered an exuberant assessment of the Columbia Clinic movement, declaring that "evidence keeps on piling on top of evidence to the effect that the Columbia Clinic is just proving to be, and will yet stand as the most important effort sponsored for our group in Columbia within the last half century. ("76) The deteriorating economic conditions of both the state and the people and the ravages of the Great Depression made it impossible to sustain this effort. But the ramifications of the Columbia Clinic movement continued well into the next decade. It taught the citizens a powerful lesson concerning the processes of black mobilization and thus raised, as Evans anticipated, black consciousness about the necessity to apply pressure on the state in order to achieve changes that generated greater access to opportunity.

In December 1931 black professionals in Columbia showed graphic evidence of the impact of a heightened racial and class consciousness arguably generated by Evans's Columbia Clinic movement. They challenged a white-initiated proposal to institutionalize the separation of black health-care delivery. A committee that included one of the most prominent black lawyers in the state, Nathaniel J. Frederick, physicians and dentists J. C. Anderson, W. H. Harvey, T. M. Boykin, T. L. Duckett, R. S. Lawrence, and Zion Baptist Church pastor J. P. Reeder drafted a set of resolutions in response to a Richland County proposal to add a black annex to the Columbia Hospital. (77) The committee called a mass meeting that took place at Allen University in Columbia. The sentiment of the meeting was that African Americans should demand "a real hospital for Negroes." The Palmetto Leader reported the conversation and published the resolution. The people expressed firm opposition to the idea of an annex. They were "so unalterably opposed to the present plan as gathered from information published in the daily papers that the colored citizens of Richland County prefer not to have any provision made for them along the lines indicated...." The citizenry went one step further according to the Palmetto Leader. They "respectfully request[ed] the foundations that have expressed themselves as being willing to aid in the erection of a hospital for colored people not to contribute any money looking to any such arrangement for the colored people." (78)

The resolution opened with a strong declaration of entitlement. "The Negro citizens of Richland [C]ounty are entitled to a complete hospital for the proper care of their sick and not merely an annex to the white hospital." The resolution captured precisely their insistence that only a permanent structure equipped with a nursing training school and a residence for the student nurses constituted "a real hospital for Negroes." "A real hospital should be established for the colored people, looking to its expansion to fulfill the needs not for a month or a year but for the next 25 or 50 years." Furthermore, "A real hospital should be established wherein colored nurses could be trained the same as in white hospitals and for the accommodation of such nurses there should be established a home." (79)

This display of the black community's resolve and its rejection of white attempts to assume unilateral control over black health-care delivery marks an important stage in the evolution of race relations in South Carolina. The movement to end black subordination would gather force over the course of the next three decades. It was a slow and complicated process that witnessed alternately both rejection and acceptance of the strategy of "black parallelism." While the proposal to create a separate black annex to the white hospital was resoundingly rejected in 1931, the establishment in the late 1940s of a black law school at South Carolina State College would be applauded. Was one an instance of progress and the other a step backward?

In 1947 the state decided to create a separate black law school at South Carolina State College in Orangeburg in order to preserve the white racial purity of the law school at the University of South Carolina. The black community overrode the strident objections of Thurgood Marshall and the National Association for the Advancement of Colored People to accept the offer. Ironically, the graduates of the black law school would eventually help to destroy legally sanctioned segregation in the Palmetto State. Between 1947 and 1966 the South Carolina State law school awarded bachelor of laws degrees to fifty male students and one female student, Laura A. Ponds (class of 1965). (80) Perhaps the difference between the two cases was that the law school would be located at a historically black institution, while the proposed annex would have been a part of the all-white Columbia Hospital, with little if any black autonomy. Furthermore, the black annex may have threatened the existence of the two proprietary hospitals that leading black physicians operated in the city.

The Great Depression and its severe economic dislocations further eroded black professional-class advocacy of parallelism and helped fuel the slow transition to advocacy of equality of opportunity. This is not to suggest that there was wholesale abandonment of the strategy of parallelism. Rather, as black professionals became more critical of second-class treatment by the state, they modified and shifted that ideology. An economically ravaged black community could ill afford to sustain parallel health-care institutions. Too few doctors and nurses were graduated from the parallel institutions to meet the needs of a growing black population. Thus black parallelism as a practical strategy for meeting repression by white supremacists began to crumple in the face of new economic crises, black migration, and increased militancy, ff black physicians and nurses were to avoid professional-class suicide, they had to abandon the quest for nominal space within "separate but equal" and demand their citizenship rights. When Matilda Evans died on November 17, 1935, of nephritis and a cerebral hemorrhage, these changes in black professional- and business-class interests were evident. (81)

What are we to make of Dr. Evans's life and work? In relating her career, I have assumed that she consciously engaged in sophisticated, multilayered forms of resistance and creative engagement. But at what level and in what fashion did she resist the forces of racial oppression and exploitation? It would be too easy to posit that she accommodated white supremacy and supported white separatism. Such an analysis would, perhaps, explain why she received remarkable varieties of support from white medical colleagues and cash contributions from other prominent white citizens. Evans attended an interracial clientele that included many well-to-do white women. Unlike her poorer black patients, the white women paid fees. Their payments permitted Evans the means to heal the poor without charge. White beneficence helped Evans keep afloat. Yet it could also be argued that by creating Taylor Lane Hospital in the early stage of her career, Evans diffused or silenced objections some blacks might otherwise have voiced about the lack of access to the municipal hospital that their taxes helped to maintain.

Evans adroitly adapted black parallelism to secure an operational niche within the "separate but equal" racial regime that was indeed separate but never equal. Functioning successfully within the social, economic, and political spheres of white domination enabled Evans to meet the critical health-care needs of the most vulnerable. Late in her career Evans edited newsletters and became an active local participant and leader in the broader Negro health movement. She rebelled against the boundaries of race and assumed a critical public voice in her publications. Evans's writings often critiqued capitalism and the low-wage exploitation of black workers. We do not know how rare or unique she was as an outspoken black woman professional in this era so dominated by the male voice. But we do know that, rather than advocate direct confrontation or violent resistance to the reality of inequality, she merged concern for her community's health welfare with the material interests of capitalists. For example, Evans declared that her "Negro Health Association of South Carolina [was] an important institution worthy of the unstinted support of the people of all races." She pointed out to South Carolina's white economic elites that they needed healthy workers in order to maximize profits, and she connected black health to the whites' imperative to safeguard the health of white families from contamination by the bodies of black domestic employees. Again, Evans's writings reflect her practice of a strand of interactive resistance. In both writings and lectures she addressed audiences that crossed the divides of race and class. In the last half of her life she revealed a clear sense of her missions as a health-care and community leader and as a professional who had the responsibility to educate white as well as black citizens, the rich as well as the poor. "It is the opinion of the Journal that the people desire to escape disease and death ... and that they may be counted upon to cooperate with health authorities in all work promising them health and strength and long life.... When the leaders are ready to tell them what is to be done they will be quick to do it." (82)

Evans's religious piety, shaped in fundamental ways by her mentor, Martha Schofield, discerned no impenetrable barrier between the material and spiritual worlds. Thus she cloaked or adorned her call for redistribution of economic and medical resources in the rhetoric of combating evil. As was true in the experiences of many activistic black women, the black church provided an institutionalized space from which to launch the Columbia Clinic movement. In the execution of an interactive strategy of resistance Evans carved out a unique terrain within which she could not only demonstrate professional competence but also persuade the state to playa meaningful role in ensuring black survival. (83) Evans's life provides a rich template for understanding the complexity of southern history and the professional space that a few black women occupied during the era of white separatism. Furthermore, Evans masterfully conjoined subtle and brilliant intellectualism to the physician's professional skill and the black clubwoman's politics of respectability, piety, and service. This combination enabled her to counter hopelessness in the soul of her people and to strengthen their bodies and minds, especially of the children who would fight the long war for full citizenship rights. Hence Evans's career is surely a triumph of interactive resistance. She played an important role and was an essential link between the past struggle for survival and the future civil rights movement of the 1950s and 1960s.

Health and health care are issues of enduring significance to African Americans. Statistics and commentary on morbidity and mortality appear frequently in black periodicals, magazines, and newspapers. (84) Health status remains a critical marker of how well black people are progressing in the long struggle for first-class citizenship and equality of opportunity. Historians have devoted considerable attention to the black political quest for voting rights and to the legal struggle against segregation and discrimination in public accommodations and education. However, the past, present, and future crises in health, both on the national and international levels, demand that scholars also provide in-depth historical perspectives on the politics of health and health-care delivery. One way to promote this work is to excavate the stories and write case studies of individuals who devoted their lives and careers to efforts not only to cure disease and become professionals but also to reform society. For black professionals the struggle was always complicated by the enormous burden of the intersection of race, class, gender, and region. They fought for the right to enter and to establish practices in the healing professions against twin backdrops of industrialization and urbanization on the one hand and, on the other, the growing concentration of the wealth and power of a white male plutocracy. Their individual and collective stories were always and inextricably both southern and American. This case study, the recounting and accounting of the life and work of Matilda A. Evans, demonstrates the extent to which the thread of race makes southern history our American history.

(1) W. E. B. Du Bois, The Souls of Black Folk: Essays and Sketches (1903; reprint, Greenwich, Conn., 1961), 16-17. Carter Godwin Woodson argued that "[i]n organizing the people ... and in stimulating their effort to battle for their rights the Negro physician has contributed more than any other class, with the possible exception of the Negro lawyer, toward enlarging the domain of individual liberty and securing for a despised element a hearing at the bar of public opinion." Woodson, The Negro Professional Man and the Community, with Special Emphasis on the Physician and the Lawyer (1934; reprint, New York, 1969), 126. Philosopher Robert Gooding-Williams posed the provocative question as to whether Du Bois's veil was corporeal or ocular at the centennial celebration symposium on The Souls of Black Folk at the University of Wisconsin, Madison, in April 2003. In a follow-up conversation a month later I suggested to him that the metaphor of "the veil" could be interpreted as representing both an ocular and a corporeal (meaning the physical body of black people that whites refused to see except as laborers, and the efforts of black people to establish themselves as significant members of the body politic and to demand the full rights of citizenship, especially the right to state-supported care for their bodies) metaphor. I gratefully take this opportunity to thank the historians who provided invaluable comments on earlier drafts of this essay: William C. Hine, Aldon D. Morris, Leslie Moch, Pero Dagbovie, Joe W. Trotter, Susan Reverby, Regina Morantz Sanchez, Deborah Gray White, Evelyn Hammonds, Neil Irvin Painter, Wanda Hendricks, Rosalyn Terborg-Penn, Wilma King, Stephanie Shaw, Elsa Barkley Brown, Lisa Fine, Kathleen Thompson, Hilary Mac Austin, John lnscoe, William B. Hixson, and Marshanda Smith.

(2) "Dr. Matilda A. Evans: Noted Physician and Surgeon, Humanitarian, Outstanding Citizen of Columbia," Columbia (S.C.) Palmetto Leader, March 22, 1930, p. 1. The Palmetto Leader was a Columbia, S.C., newspaper edited by a prominent black attorney, Nathaniel Frederick. The article is so laudatory that Dr. Evans may well have written it herself (though John R. Wilson is listed as author). The biographical details mentioned in my introductory paragraphs will be elaborated upon and documented in the pages that follow.

(3) Jane Van De Vrede quoted in Karen Buhler-Wilkerson, "Guarded by Standards and Directed by Strangers: Charleston, South Carolina's Response to a National Health Care Agenda, 1920-1930," Nursing History Review, 1 (1993), 143.

(4) Matilda A. Evans, Martha Schofield, A Pioneer Negro Educator," Historical and Philosophical Review of Reconstruction Period of South Carolina (Columbia, S.C., 1916).

(5) Columbia Palmetto Leader, November 26, 1932, supplement.

(6) John Egerton, Speak Now Against the Day: The Generation Before the Civil Rights Movement in the South (New York, 1994), 102-3.

(7) Columbia (S.C.) State. October 29, 1931, p. 3; [Matilda A. Evans], A Brief History of the Evans Clinic (Columbia, S.C., 1932).

(8) Evans, Martha Schofield, 82.

(9) Darlene Clark Hine, "Black Professionals and Race Consciousness: Origins of the Civil Rights Movement, 1890-1950," Journal of American History, 89 (March 2003), 1279-94; Hine, Black Victory: The Rise and Fall of the White Primary in Texas (1979; new ed., Columbia, Mo., 2003), chap. 9. Also see Hine, Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890-1950 (Bloomington, 1989).

(10) Charles Lemert and Esme Bhan, eds., The Voice of Anna Julia Cooper: Including A Voice From the South and Other Important Essays, Papers, and Letters (Lanham, Md., 1998), 7. There are striking similarities between Evans's and Cooper's construction of their families. Evans like Cooper remained childless but nevertheless reared at least seven children, three of whom were her orphaned nieces and nephews. Moreover, Evans served as a foster mother to twenty-seven children over the course of her life. Cooper's biographers noted, "Over the years Cooper reared seven children--two foster children when she was young and the five orphans she adopted just shy of her sixtieth year.... [S]he cared for these children on a teacher's salary while, among so much else, commuting to New York City and Paris in pursuit of her doctoral degree" (p. 8). On Evans see the biographical sketch of Matilda Arabelle Evans written by her niece Jessie T. Hill, June 1992, in the Matilda Arabelle Evans Collection (South Caroliniana Library, University of South Carolina, Columbia). For biographical studies of black women social reformers see Jacqueline Anne Rouse, Lugenia Burns Hope: Black Southern Reformer (Athens, Ga., 1989); Glenda Elizabeth Gilmore, Gender and Jim Crow: Women and the Politics of White Supremacy in North Carolina, 1896-1920 (Chapel Hill, 1996), 177-202 (on Charlotte Hawkins Brown); Elsa Barkley Brown, "Womanist Consciousness: Maggie Lena Walker and the Independent Order of Saint Luke," Signs, 14 (Spring 1989), 610-33; Joyce A. Hanson, Mary McLeod Bethune and Black Women's Political Activism (Columbia, Mo., 2003); Merline Pitre, In Struggle Against Jim Crow: Lulu B. White and the NAACP, 1900-1957 (College Station, Tex., 1999); and Vicki L. Crawford, Jacqueline Anne Rouse, and Barbara A. Woods, eds., Women in the Civil Rights Movement: Trailblazers and Torchbearers, 1941-1965 (Brooklyn, 1990), esp. Woods, "Modjeska Simkins and the South Carolina Conference of the NAACP, 1939-1957," pp. 99-120. Each woman blended maternal, familial, professional, and social activist roles seemingly seamlessly into a public/private identity that defined and exemplified a womanist consciousness. Yet this is not to say that they did not use the culture of dissemblance to protect and nurture an inner self while giving the impression of openness.

(11) Rayford W. Logan, The Negro in American Life and Thought: The Nadir, 1877-1901 (New York, 1954). Historian E. H. Beardsley challenges historians to think anew about our treatment and perceptions of the black middle class in the first half of the twentieth century. "Supposedly, this group was so eager for white acceptance and so fearful of being lumped with the mass of 'shiftless' blacks, that it turned its back on the poor and virtually repudiated its own membership in the race." Beardsley, "William D. Chappelle, Jr., M.D.: A Physician and Churchman in South Carolina," A.M.E. Church Review, 117 (April-June 2001), 54-62 (quotation on p. 54).

(12) I define black parallelism as the development of an ideology, strategy, and the necessary institutions and organizations to ensure survival of the community and to combat all manner of racial discrimination and segregation. Feminist scholars have employed the concept of female separatism in similar ways. Historian Estelle Freedman argues that "the creation of a separate, public female sphere helped mobilize women and gained political leverage in the larger society. A separatist political strategy, which I refer to as 'female institution building,' emerged from the middle-class women's culture of the nineteenth century." Freedman, "Separatism as Strategy: Female Institution Building and American Feminism, 1870-1930," Feminist Studies, 5 (Fall 1979), 512-29 (quotation on p. 513).

(13) Leon F. Litwack, Trouble in Mind: Black Southerners in the Age of Jim Crow (New York, 1998), 233.

(14) Rayford Whittingham Logan, The Betrayal of the Negro from Rutherford B. Hayes to Woodrow Wilson (1954; rev. ed., New York, 1997), 345.

(15) Cynthia Neverdon-Morton, Afro-American Women of the South and the Advancement of the Race, 1895-1925 (Knoxville, 1989), 9. For many African Americans the antilynching movement was a significant dimension of the Progressive era. "[Ida B.] Wells-Barnett made lynching a legitimate focus of American reform, amenable to the signal social remedies of the Progressive era: education and protective legislation." Patricia A. Schechter, Ida B. Wells-Barnett and American Reform, 1880-1930 (Chapel Hill, 2001), 122. Woman suffrage was another significant reform measure that attracted widespread support from black women. Historian Rosalyn Terborg-Penn maintains that "African American women championed the suffrage movement in much the same way that Blacks generally supported the Populists and the Progressive movement--bypassing elements of the movements that deterred them, but defending basic and inclusive, democratic concepts." Terborg-Penn, African American Women in the Struggle for the Vote, 1850-1920 (Bloomington, 1998), 112-15 (quotation on p. 112).

(16) Herbert M. Morais, The History of the Negro in Medicine (New York, 1967), 68. State black medical associations preceded the founding of the National Medical Association. For example, a group of black graduates of the Leonard Medical School of Shaw University in Raleigh, North Carolina, met in 1887 to found the Old North State Medical, Dental, and Pharmaceutical Society, Inc. The three founders included Drs. M. T. Pope (class of 1886), J. T. Williams (class of 1886), and L. A. Scruggs (class of 1886). They were joined by Dr. A. M. Moore (class of 1888), who became one of the founders of the North Carolina Mutual Life Insurance Company. In 1910 there were 3,777 physicians, 478 dentists, and 2,433 trained nurses in the United States. Souvenir Program of the Old North State Medical, Dental and Pharmaceutical Society, Inc. (Fiftieth Annual Session, Golden Jubilee, June 1, 2, 3, 1937, North Carolina College for Negroes, Durham, N.C.). The name was changed in 1906 from the North Carolina Medical and Pharmaceutical Society to the North Carolina Medical, Dental, and Pharmaceutical Society. I thank Mrs. Irene Clark of Raleigh, North Carolina, for copies of the programs of the 1930 and 1937 annual meetings.

(17) Hine, Black Women in White, 94. For an advertisement of the St. Luke's Hospital and Evans Sanitarium see Negro Health Journal, 1 (September 1916), 6. In this issue of her journal Dr. Evans reveals her entrepreneurial activities by advertising the sale of "Villanova, pure, sparkling Spring Water from Dr. M. A. Evans' farm three and one-half miles east of Columbia" (p. 4). A copy of this issue is in the Evans Collection.

(18) In addition to Evans's St. Luke's Hospital and Evans Sanitarium, black physicians founded two hospitals in Columbia in the 1920s, the Good Samaritan Hospital (Dr. S. E. Green, Superintendent) and Waverly Fraternal Hospital (Dr. N. A. Jenkins, Superintendent). Columbia Palmetto Leader, October 18. 1930; Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York and Oxford, 1995), 120.

(19) Dr. I. A. Macon (secretary of the Palmetto Medical Association), "Colored Doctors: Met in Darlington, Several Business Meetings Held, Banquet Also Toasts," Darlington (S.C.) News, May 2, 1907. The meeting took place in Dartington, South Carolina, at the St. James M. E. Church, April 24, 1907. The 1908 meeting was held in Orangeburg, South Carolina. For a discussion of the founding of the Charleston Hospital and Training School for Nurses and its significance as a community institution under the leadership of members of the black professional class, see Hine, Black Women in White, 54 57.

(20) Macon, "Colored Doctors."

(21) "The Rurals and the Medicos," Columbia Palmetto Leader, July 16, 1932. The editorial concluded, "We believe that a splendid service might be performed by our doctors were they to hold clinics throughout the state at regular and stated intervals. The death rate among our people is bound to continue high until there is more of concerted effort on the part of our own health forces to render both preventive and therapeutic service in the case of our rural citizens."

(22) C. Calvin Smith, "Serving the Poorest of the Poor: Black Medical Practitioners in the Arkansas Delta, 1880-1960," Arkansas Historical Quarterly, 57 (Autumn 1998), 291; James Summerville, "Formation of a Black Medical Profession in Tennessee, 1880-1920," Journal of the Tennessee Medical Association, 76 (October 1983), 644-45; Jill Quadagno and Steve McDonald, "Racial Segregation in Southern Hospitals: How Medicare 'Broke the Back of Segregated Health Services,'" in Elna C. Green, ed., The New Deal and Beyond: Social Welfare in the South since 1930 (Athens, Ga., 2003), 119-37.

(23) Paul Start, The Social Transformation of American Medicine (New York, 1982), 112-23. The black medical colleges were as follows: Lincoln University School of Medicine, Oxford, Pennsylvania, 1870-1874; Straight University Medical School, New Orleans, 1873-1879; Flint Medical College of New Orleans University, New Orleans, 1889-1911; Leonard Medical School of Shaw University, Raleigh, 1882-1918; Louisville National Medical College (LNMC), Louisville, 1888-1912; State University Medical Department (merged with LNMC in 1903), Louisville, 1899-1903; Hannibal Medical College, Memphis, 1889-1896; Chattanooga National Medical College, Chattanooga, 1899-1908; and University of West Tennessee College of Medicine and Surgery, in two locations--Jackson, Tennessee, 1900-1907, and Memphis, 1907-1923. The two that survived for a significant period beyond the Flexner Report were Howard University College of Medicine, Washington, D.C., 1868-present; and Meharry Medical College, Nashville, 1876-present. H. A. Callis, "The Need and Training of Negro Physicians," Journal of Negro Education, 4 (January 1935), 32-41; Vanessa Northington Gamble, The Black Community Hospital: Contemporary Dilemmas in Historical Perspective (New York, 1989), 44.

(24) Steven J. Peitzman, A New and Untried Course: Woman's Medical College and Medical College of Pennsylvania, 1850-1998 (New Brunswick, N.J., 2000), 116-20.

(25) Patricia E. Sloan, "Commitment to Equality: A View of Early Black Nursing Schools," in M. Louise Fitzpatrick, ed., Historical Studies in Nursing: Papers Presented at the 15th Annual Stewart Conference on Research in Nursing, March 1977 (New York, 1978), 68-85; Gamble, Black Community Hospital, 9. Dr. Daniel Hale Williams founded Provident Hospital in 1891. According to historian Wanda A. Hendricks, he made it "a model of black and white cooperation. It had an interracial staff, admitted patients of all races, and was governed by an interracial board of trustees." Such an example of interracial cooperation would have been impossible in the South. The nurse training school at Provident Hospital, as Hendricks notes, attracted women from twenty-four states, Canada, and the West Indies. "By 1913. 118 nurses had graduated. Many went to work in the South." Hendricks, Gender, Race, and Politics in the Midwest: Black Club Women in Illinois (Bloomington, 1998), 59-60. Gamble points out that Dr. Williams's interracial model of Provident Hospital faltered in the early twentieth century. "In its first year of operation, the hospital admitted 189 patients--155 black and 34 white.... By 1915, 93% of the patients were black." The Great Migration of southern African Americans to Chicago, according to Gamble, "resulted in a rise in white hostility and racism." Provident "evolved into a black institution" as a response to this escalation in racial antipathy. Gamble concludes, "[B]lack leaders created separate institutions, organizations, and businesses to serve Chicago's black population and Provident Hospital emerged as a center of this 'black metropolis.'" Gamble, Black Community Hospital, 12-13.

(26) Gamble, Making a Place for Ourselves, chap. 2; Hine, Black Women in White; Dennis C. Dickerson, "Family, Faith and the Making of a Black Female Physician: Emma Ann Virginia Reynolds, M.D., 1862-1917," A.M.E. Church Review, 117 (April-June 2001), 35-38. Historian Dickerson details the role that Emma Reynolds played in inspiring Daniel Hale Williams to establish the Provident Hospital and Nursing Training School in Chicago. She was its first nursing student, and she subsequently earned an M.D. degree in 1895 from Northwestern University (pp. 36-37). See also Janet Wilson James, "Writing and Rewriting Nursing History: A Review Essay," Bulletin of the History of Medicine, 58 (1984), 568-84.

(27) Hine, Black Women in White, 41-43, 63-65.

(28) Darlene Clark Hine, "Rape and the Inner Lives of Black Women in the Middle West: Preliminary Thoughts on the Culture of Dissemblance," Signs, 14 (Summer 1989), 912-20.

(29) Biographical sketch of Matilda Arabelle Evans written by her niece Jessie T. Hill, June 1992, in the Evans Collection. Evans's brother and sister were named Andy and Aurora.

(30) James D. Anderson, The Education of Blacks in the South, 1860-1935 (Chapel Hill, 1988); George Brown Tindall, South Carolina Negroes, 1877-1900 (Columbia, S.C., 1952); Walter Edgar, South Carolina: A History (Columbia, S.C., 1998), 407-52; Leslie A. Schwalm, A Hard Fight For We: Women's Transition from Slavery to Freedom in South Carolina (Urbana, 1997).

(31) Schwalm, Hard Fight for We, 267-68; Tera Hunter, To 'Joy My Freedom: Southern Black Women's Lives and Labors After the Civil War (Cambridge, Mass., 1997); Booker T. Washington, "The Standard Printed Version of the Atlanta Exposition Address," Atlanta, September 18, 1895, in Louis R. Harlan, ed., The Booker T. Washington Papers (14 vols.; Urbana. 1972-1989), III, 586.

(32) Evans, Martha Schofield, 19 (first three quotations), 35 (fourth quotation). Evans described the school at the time of Schofield's death in 1916 as consisting of eight buildings over two city blocks in Aiken and four hundred acres nearby. Evans writes that Schofield's venture was made possible by "the old Abolitionists, who supported her institution generously as long as they lived and possessed the means to do so" (p. 12).

(33) Biographical note, Dr. Matilda Evans, Class of 1892, Oberlin Alumni Magazine, April 1930, p. 218. Evans provided this information to George M. Jones, Secretary, Oberlin College, May 30, 1908; copy of the form found in the Evans Collection.

(34) Among the black women graduates of the Woman's Medical College who practiced in the South were Verina M. Harris Morton Jones (class of 1888), who was the first woman to pass Mississippi State Boards. She served as resident physician at Rust College in Holly Springs, Mississippi. Halle Tanner Dillon Johnson (class of 1891) was the first black woman to pass the Alabama State Boards. She served as resident physician at Tuskegee Institute, 1891 1894. Alice Woodby McKane (class of 1892) co-founded with her husband, Dr. Cornelius McKane, the McKane Hospital for Women and Children and Training School for Nurses in Savannah, Georgia, in 1896. Drs. Lucy Hughes Brown (class of 1894) and Matilda A. Evans (class of 1897) were the first women physicians in South Carolina. Both played leading roles in establishing hospitals and in training black women nurses in Charleston and Columbia respectively. Darlene Clark Hine, "Co-Laborers in the Work of the Lord: Nineteenth-Century Black Women Physicians," in Ruth J. Abram, ed., "Send Us A Lady Physician": Women Doctors in America, 1835-1920 (New York, 1985), 107-20; Bettina Aptheker, "Quest for Dignity: Black Women in the Professions, 1865-1900," in Aptheker, Woman's Legacy: Essays on Race, Sex, and Class in American History (Amherst, Mass., 1982), 89-110; Peitzman, New and Untried Course, 116-20.

(35) Matilda A. Evans to Alfred Jones, March 13, 1907, Evans Collection. Evans wrote the letter seeking support for one of her nursing students who showed unusual promise. For a discussion of this student's postgraduate experiences see Vanessa Northington Gamble, "'I am a Negro Woman, Graduate of the Woman's Medical College of Pennsylvania: 1910." The Life and Career of Dr. Melissa Evelyn Thompson Coppin," A.M.E. Church Review, 117 (April-June 2001), 39-44.

(36) Evans to Jones, March 13, 1907, Evans Collection (quotation); "Dr. Matilda A. Evans: Noted Physician and Surgeon," 1. One of the earliest black-authored profiles of Evans concluded that "it should be said that while Dr. Evans did not get to Africa, she has through her charity work, which has been boundless, been able to minister to thousands of her people who but for her devotion must have been without treatment and advice they so sorely needed." A. B. Caldwell, History of the American Negro: South Carolina Edition (Atlanta, 1919), 396.

(37) Evans to Jones, March 13, 1907, Evans Collection (quotation); Hine, Black Women in White, 54; Sara W. Brown, "Colored Women Physicians," Southern Workman, 52 (December 1923), 588; and information on Lucy Hughes Brown in McClennan-Banks Memorial Hospital Manuscript Collection (Waring Historical Library, Medical University of South Carolina, Charleston). Lucie Bragg Anthony (Meharry Medical College, class of 1907) became supervisor of county schools in Sumter, South Carolina. She focused her efforts on a combination of "health work, literacy work, and teacher training." She facilitated the establishment of more than two dozen new schools. Aptheker, "Quest for Dignity," 102.

(38) Aptheker, "Quest for Dignity." 93. Aptheker notes that Sarah Mapps Douglass (1806-1882) was "[t]he first Black woman to complete a medical course at an American university": "She attended the Ladies' Institute of the Pennsylvania Medical University for three years, completing her studies in 1858." Rebecca Lee was the first black woman physician in the U.S. In 1864 she graduated from the New England Female Medical College and shortly thereafter established a practice in Richmond, Virginia (p. 97). The second black woman physician was Rebecca Cole (1846-1922), who graduated in 1867 from the Woman's Medical College in Philadelphia. She "spent the Reconstruction years in Columbia, South Carolina," before returning to Philadelphia and subsequently settling in Washington, D.C., where she served as superintendent of the Government House for children and elderly women (p. 98).

(39) Anderson, Education of Blacks in the South, 24546 (quotation on p. 245); Mary Roth Walsh, "Doctors Wanted, No Women Need Apply": Sexual Barriers in the Medical Profession, 1835-1975 (New Haven, 1977), 186. For lawyers the black ratio was 1 to 12,315, and 1 to 718 among whites.

(40) Matilda Evans to Miss Crocker, Schofield School, May 5, 1922, Evans Collection. In 1896 Drs. C. C. Johnson of Columbia and A. C. McClennan of Charleston, along with a half-dozen other physicians, organized the Palmetto Medical, Dental, and Pharmaceutical Association in order "to bring the members of the profession into closer relationship, that would create a better understanding and secure a more concerted action in solving the problems then confronting the profession." According to the program for the April 1924 meeting the membership consisted of seventy-four physicians, twenty-eight dentists, and twenty-three pharmacists. Matilda Evans participated as a discussant in two symposia, one on gonorrhea and the other on syphilis. Minutes of the Twenty-ninth Annual Session of the Palmetto Medical Association of the State of South Carolina, Rock Hill, S.C., April 22-24, 1924. One program proudly proclaimed, "[O]ther colored medical associations are older but this is the only one that has never missed a meeting since organization. When organized it consisted of eight colored physicians. Today the membership total nearly eighty." Of the twenty-seven presidents listed in the program, only Matilda A. Evans was a woman. Minutes of the Thirtieth Annual Session of the Palmetto Medical Association, State College Auditorium, Orangeburg, S.C., April 28-30, 1925. The association divided the state into four sections, each with its own medical organization: the Charleston County Medical, Dental. and Pharmaceutical Association; the Inter-County Medical, Dental, and Pharmaceutical Association; the Congaree Medical, Dental, and Pharmaceutical Association; and the Piedmont Medical, Dental, and Pharmaceutical Association. Copies of the minutes are located in the Palmetto Medical, Dental, and Pharmaceutical Association Collection (Miller F. Whittaker Library. South Carolina State University, Orangeburg, S.C.).

(41) Taylor Lane Hospital and Training School for Nurses, Fourth Annual Report (Aiken, S.C., 1906). Pages not numbered. Copy in South Caroliniana Library, Columbia, S.C.

(42) C. A. Johnson, "Negroes," in Helen Kohn Hennig, ed., Columbia: Capital City of South Carolina, 1786-1936 (Columbia, S.C., 1936), 303-14. For a critical analysis of the prevalent negative images of and attitudes toward black women during this era see Beverly Guy-Sheftall, Daughters of Sorrow: Attitudes Toward Black Women, 1880-1920 (Brooklyn, 1990); Patricia Morton, Disfigured Images: The Historical Assault on Afro-American Women (New York, 1991); and Deborah Grey White, Too Heavy A Load: Black Women in Defense of Themselves, 1894-1994 (New York, 1999). Black men's views are treated in Rosalyn Terborg-Penn, "Black Male Perspectives on the Nineteenth-Century Woman," in Sharon Harley and Terborg-Penn, eds., The Afro-American Woman: Struggles and Images (Port Washington, N.Y., 1978), 23-42; and Paula Giddings, When and Where I Enter: The Impact of Black Women on Race and Sex in America (New York, 1984).

(43) Columbia (S.C.) State clipping in Evans Collection (quotations) (The date is smudged and indecipherable; copy in author's possession.); Negro Health Journal, 1 (September 1916). See also Burnett W. Gallman, The Shoulders We Stand On (Columbia, S.C., 1999), 30-31. "In all these hospitals the training school for nurses is a conspicuous feature, and the nurses who receive this training show very great efficiency, finding employment largely among the white people, who frequently prefer them to white nurses with similar training. Some of these institutions have been built up through the enterprise of individual colored physicians. A notable example is the 'St. Luke's Hospital' at Columbia, founded and maintained in the face of many discouragements, by Dr. Matilda A. Evans.... Hospitals of this type are held in high esteem by the communities in which they are located and are centers of beneficence for the country around." Thomas Jesse Jones, ed., Negro Education: A Study of the Private and Higher Schools for Colored People in the United States (Washington, D.C., 1917), 176.

(44) Caldwell, History of the American Negro, 393-94, 396 (first quotation on p. 394; second quotation on p. 396).

(45) Evans, Martha Schofield, 12-13.

(46) Columbia (S.C.) State clipping in Evans Collection; F. D. Kendall, M.D., to whom it may concern, in Taylor Lane Hospital and Training School for Nurses, Fourth Annual Report.

(47) Columbia (S.C.) State clipping in Evans Collection (first quotation); "Dr. Matilda A. Evans: Noted Physician and Surgeon," p. 1 (other quotations).

(48) Evelyn Brooks Higginbotham, Righteous Discontent: The Women's Movement in the Black Baptist Church, 1880-1920 (Cambridge, Mass., 1993), 194.

(49) Maritcha R. Lyons, "Introduction," in S. Maria Steward, Woman in Medicine: A Paper Read Before the National Association of Colored Women's Clubs at Wilberforce, Ohio, August 6, 1914 (Wilberforce, Ohio, 1914), 4 (first and second quotations), 5 (third quotation). Many professional women found it necessary to emphasize their feminine qualities as they maneuvered through the course of careers in male-dominated occupations. Occasionally a woman professional contradicted "the sentimental narrative" of being "a motherly, selfless, self-sacrificing Lady Bountiful whose only desire was to end the suffering of poor women...." For an illuminating discussion of a white woman physician who transgressed the sentimental narrative see Regina Morantz-Sanchez, Conduct Unbecoming a Woman: Medicine on Trial in Turn-of-the-Century Brooklyn (New York and Oxford, 1999), 213.

(50) Thirteenth Census of the United States, Taken in the Year 1910. Volume One. Population, 1910: General Report and Analysis (Washington, D.C., 1913), 86, 180; Taylor Lane Hospital and Training School for Nurses, Fourth Annual Report (quotations). For a discussion of the qualities valued in the black nurse and for a comparative perspective on how different communities organized their health-care delivery see Karen Buhler-Wilkerson, "Caring in Its 'Proper Place': Race and Benevolence in Charleston, SC, 1813-1930," Nursing Research, 41 (January-February 1992), 14-20. For a discussion of the history of early southern hospitals and training schools and the financial relations between school officials and student nurses, see Hine, Black Women in White, 50-58. Also see Susan M. Reverby, Ordered to Care: The Dilemma of American Nursing, 1850-1945 (Cambridge, Eng., 1987); and David Rosner, A Once Charitable Enterprise: Hospitals and Health Care in Brooklyn and New York, 1885-1915 (Cambridge, Eng., 1982).

(51) George Bunch, M.D., to whom it may concern, December 28, 1906, Evans Collection.

(52) Taylor Lane Hospital and Training School for Nurses, Fourth Annual Report.

(53) W. Montague Cobb, "Special Problems in the Provision of Medical Services for Negroes," Journal of Negro Education, 18 (Summer 1949), 342.

(54) John T. Duncan to whom it may concern, December 6, 1906, Evans Collection.

(55) Taylor Lane Hospital and Training School for Nurses, Fourth Annual Report.

(56) William Weston, M.D., to whom it may concern, in Taylor Lane Hospital and Training School for Nurses, Fourth Annual Report.

(57) Biographical sketch of Matilda Arabelle Evans written by her niece Jessie T. Hill, June 1992, in the Evans Collection. Evans participated regularly in the meetings of the local black medical association as well as in the state organization. One newspaper account reported on the monthly meeting of the Congaree Medical Society that Dr. N. A. Jenkins hosted at his home. "There were quite a few of the professional men present including the only lady doctor, who is a member in [the] person of Dr. M. A. Evans." Columbia Palmetto Leader, July 17, 1926, p. 2.

(58) Charlotte (N.C.) Observer, November 20, 1932, clipping in Evans Collection.

(59) Evans, Martha Schofield, 97.

(60) Anderson, Education of Blacks in the South, 278.

(61) Evans, Martha Schofield, 55 (first quotation), 107 (second and third quotations), 108 (fourth and fifth quotations).

(62) Ibid., 109.

(63) [Evans], "Cheap Living, Poverty, Disease and Death Lay Heavy Annual Tax on People Everywhere," Negro Health Journal, 1 (September 1916), I (first quotation); [Evans], "How Business Would Profit by the Paymennt [sic] of Better Wages to Negroes," ibid., p. 5 (other quotations). While there is no byline naming Evans as author, the style and language of the pieces sufficiently resemble her other writings that I am assuming that she wrote these articles.

(64) Alex Lichtenstein, "Theft, Moral Economy, and the Transition from Slavery to Freedom in the American South." in Stephan Palmie, ed., Slave Cultures and the Cultures of Slavery (Knoxville, 1995), 176-86. Lichtenstein argues that "when slaves stole from slaveowners, they engaged in an act of resistance rooted in what I (following E. P. Thompson and other historians of eighteenth-century Britain) call a moral economy that did indeed pose an alternative view of property relations" (p. 176). Theft (or "taking," as Evans referred to it) remained "a crucial issue in defining property relationships between whites and blacks in the plantation South, even after emancipation" (p. 178).

(65) "Contributions of Money Needed Immediately," Negro Health Journal, 1 (September 1916), 3.

(66) Paul Lofton, "The Columbia Black Community in the 1930's," Proceedings of the South Carolina Historical Association (1984), 89.

(67) William H. Tucker, The Funding of Scientific Racism: Wickliffe Draper and the Pioneer Fund (Urbana, 2002), 14-15.

(68) Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women's Health Activism in America, 1890-1950 (Philadephia, 1995), 29.

(69) Columbia Palmetto Leader, June 21, 1930, p. 1.

(70) Charles Payne, "Men Led, but Women Organized: Movement Participation of Women in the Mississippi Delta," in Crawford, Rouse, and Woods, eds., Women in the Civil Rights Movement, 1-11. For a discussion of how gender conventions shaped black women's involvement in the civil rights movement and an insightful discussion of social-movement theory, see Aldon D. Morris, The Origins of the Civil Rights Movement: Black Communities Organizing for Change (New York, 1984), 275-90; and Belinda Robnett, How Long? How Long? African American Women in the Struggle for Civil Rights (New York and Oxford, 1997).

(71) "Dr. Matilda A. Evans: Noted Physician and Surgeon," 1.

(72) Evans quoted in "The Columbia Clinic Association: This Institution Offers Medical Inspection and Free Vaccination to all Negro Children of This City," Columbia Palmetto Leader, September 20, 1930, p. 1. Willis C. Johnson, proprietor of the Johnson-Bradley Undertakers. served as president of the board of directors of the Columbia Clinic Association. An earlier story declare& "It should be stated that all of the doctors of our group in the city ate co-operating splendidly in this movement." Columbia Palmetto Leader, August 23, 1930, p. 1.

(73) John R. Wilson, "The Columbia Clinic An Effective Reality: Has Temporary Quarters in the Basement of Zion Baptist Church--A Number of Children Treated," Columbia Palmetto Leader, August 16, 1930, p. 1; [Evans], Brief History of the Evans Clinic.

(74) Wilson, "Columbia Clinic An Effective Reality," 1; "Columbia Clinic Association," I (quotation).

(75) "Dr. Matilda A. Evans Interviewed," Columbia Palmetto Leader, September 20, 1930. In another story the Palmetto Leader noted in passing that Dr. Evans "gives poor heed to both her physical and financial limitation when a question of service arises." October 18, 1930, p. 3. lndeed, Evans was so consumed by this project that her own health began to decline. Still, in November she arranged for the clinic to host a health-education program that included visits by "certain outstanding specialists--members of the National Medical Association ... to conduct [the] clinic along the lines of their respective speciality." "The Columbia Clinic Enlarges Its Scope of Its Endeavor," Columbia Palmetto Leader, November 8, 1930, p. 1.

(76) Columbia Palmetto Leader, September 13, 1930, p. 1; October 18, 1930, p. 1.

(77) W. Lewis Burke and William C. Hine, "The African American Bar and the Creation of the South Carolina State College Law School" (work-in-progress, cited with permission of the authors). Admitted to practice in 1913, Frederick served multiple leadership roles within the black community. In 1926 he spearheaded the reorganization of the city's NAACP chapter, and as editor of the Palmetto Leader he boldly pressed for black rights. Moreover, he cofounded the Victory Savings Bank. When Frederick died destitute in 1938, Columbia lost its only black lawyer.

(78) "Negro Annex on Columbia Hospital Grounds Not Wanted: Mass Meeting at Allen Sunday Ask for a Real Hospital for Negroes," Columbia Palmetto Leader, December 19, 1931, p. 1. Foundations such as the Duke Endowment had contributed significant sums to the development and maintenance of black community hospitals in the region. Gamble, Making a Place for Ourselves, 120.

(79) "Negro Annex on Columbia Hospital Grounds Not Wanted," 1.

(80) Burke and Hine, "African American Bar and the Creation of the South Carolina State College Law School." The state's first woman lawyer was a black woman, Cassandra Elizabeth Maxwell (1910-1974) of Orangeburg, South Carolina, who was admitted to the bar in 1939. The daughter of a prosperous grocery-store proprietor, Maxwell was graduated from Claflin University's high school in 1928. She attended Spelman College and then earned a law degree from the School of Law at Howard University, where she studied with James Nabrit and Leon Ransom. In 1941 the Howard Law graduate joined the faculty of South Carolina State College Law School, where she taught classes on contracts, credit transactions, pleading, and moot-court training. In 1951 she and her husband, Dr. James Hope Birnie (a biology professor at Morehouse College), moved to Atlanta, where she started a private practice. From 1962 until her death in 1974 the Birnies lived in Philadelphia, where she joined the Pennsylvania bar and launched another private law practice. In Philadelphia she continued advocating for social causes and greater opportunity for women and children. She worked for Fair Housing and Jobs for Youth, the Children's United Fund, the League of Women Voters, the Urban League, and the NAACP Legal Defense and Educational Fund. She was an active participant in Republican Party affairs, and President Richard Nixon appointed her as a member of the Interim Board of Directors of the Student Loan Marketing Association. She was nominated in the Republican primary as a candidate for a judgeship in the Philadelphia Court of Common Pleas. Her bid for the seat proved unsuccessful. See "Local Woman First Black Female Attorney Admitted to S.C. Bar," Orangeburg (S.C.) Times and Democrat, February 27, 2000, p. 2; and Cassandra Maxwell Birnie Collection (Miller F. Whittaker Library, South Carolina State University, Orangeburg, S.C.).

(81) Deaths: Matilda Arabelle Evans," Journal of the American Medical Association, 106 (January 1936). 232.

(82) [Evans], "Let Us Avoid Typhoid Fever by Simple Methods," Negro Health Journal, 1 (September 1916), 2.

(83) Higginbotham, Righteous Discontent; Stephanie J. Shaw, What a Woman Ought to Be and to Do: Black Professional Women Workers During the Jim Crow Era (Chicago, 1996); White, Too Heavy a Load; Gilmore, Gender and Jim Crow.

(84) Isabel Wilkerson and Angela Mitchell, "Staying Alive! The Challenge of Improving Black America's Health," Emerge (September 1991), 24-32. "As modern medicine approaches the year 2000, the health of Black America languishes in a state reminiscent of the 1940s, when practically all hospitals were segregated and flu shots a thing of the future" (p. 24). Article graphics declare "More Blacks Die of the Eight Major Killers." Noting "Incidence of Death as Compared to Whites," the article reported the following statistics: homicide/killed by police, +500 percent; kidney failure, +176 percent; diabetes, +132 percent; stroke, +82 percent; cirrhosis/liver disease, +77 percent; heart disease, +38 percent; cancer, +32 percent; and accidents, +24 percent (p. 28).

Ms. HINE is the John A. Hannah Professor of American History at Michigan State University. She delivered this paper on November 7, 2003, as the presidential address at the sixty-ninth annual meeting of the Southern Historical Association in Houston, Texas.