In the mid-1950s, Louise Cavagnaro wanted to integrate the private services. She began with Marburg. She issued no public announcements. She just did it.

Those who saw the HBO film,“Something the Lord Made,” and the PBS documentary, “Partners of the Heart,” will not soon forget the racial barriers faced by Vivien Thomas when he arrived at Hopkins in 1941. The talented surgical technician was confronted with separate rest rooms and dining facilities, discriminatory personnel policies and overt prejudice. Now, a retired administrator who worked at the Hospital from 1953 until 1985 and who played an active role in integrating its patient facilities, has detailed even more precisely the extent to which racial segregation prevailed at The Johns Hopkins Hospital and School of Medicine—and how it was eliminated.

When Louise Cavagnaro joined Hopkins, Thomas was already working in the Department of Surgery research laboratory. Because hiring practices were discriminatory, most other African Americans worked in housekeeping or dietary. Some were orderlies; a few were technicians in the operating rooms. Only one was on the full-time faculty. None were on the house staff; none were students in the medical school; and in ways that seem inconceivable today, many facilities were separate—some for “colored,” others for “white.”

This was in no way by design or the result of any articulated institutional policy. It was, rather, a reflection of the social mores of time and place. Baltimore was then very much of a southern city. Its schools, neighborhoods and public facilities were segregated.

Cavagnaro began documenting the practice at JHH in 1989. Her sources were former chief residents, longtime employees, two former Hospital presidents, Russell Nelson and Robert Heyssel; the late A. M. “Mac” Harvey, a former director of the Department of Medicine; and Richard Ross, dean emeritus of the medical faculty. Following are excerpts:

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Johns Hopkins, who came from a family who freed their slaves before the Civil War, said in his letter to his trustees that the Hospital “shall admit the indigent poor—without regard to sex, age, or color ...” Indeed, when the Hospital opened in 1889, the second patient admitted was African American—the first of many. At the end of the first full year of operation, 13.6 percent of patients at Hopkins were listed as “colored.” By 1900, it was 20.7 percent.

At the time, many other hospitals in Baltimore did not admit African Americans.

From the beginning, physicians at Hopkins accorded all patients, regardless of color, the same quality of care and respect. The earliest house staff manual (about 1950-51) notes the policy of addressing all adult patients as Mr., Mrs. or Miss, or by their special title, such as Dr. or Rev. A first name was to be used only when the patient indicated that was his or her preference.

Some public facilities were segregated; some were not. The entrances to the Hospital were open to all (although many blacks assumed the Broadway entrance was off-limits). The emergency room was never segregated, nor were the outpatient facilities (although some clinics had “colored” and “white” days). There were “colored” and “white” waiting rooms outside the general operating rooms on the bridge connecting the Carnegie and Halsted buildings. Public bathrooms were segregated and so were drinking fountains. One little girl, as the story goes, came back to her mother in tears after drinking from the fountain labeled “colored.” She was disappointed to discover that the water, in fact, was not colored at all.

Facilities for patients also were segregated. In March 1894, a two-story “colored ward” opened on Wolfe Street south of the pathology building near where Meyer stands today. In 1916, the hospital superintendent noted in his annual report that “provision for the reception of bodies of those who die in the hospital was deemed not satisfactory.” Two cement, refrigerated rooms were constructed in the Pathology Building—one for white patients, one for “colored.” These separate morgue facilities were retained until 1960.

Patients stayed in either private rooms, semi-private rooms, or on open wards. Some units were never segregated (e.g. the Harriet Lane Home, which opened for children in 1912); others were. The four wards in Osler, for example, were divided into two for “colored” (Osler 2 and 3) and two for white (Osler 4 and 6). Former chief residents recalled that when the units were crowded, blacks were occasionally admitted to empty beds in a white ward. Up until the late 1950s, black patients requesting private or semi-private rooms were not given reservations but placed on a “call list” and admitted to designated rooms.

In the blood bank, recalled Richard Ross, the former dean who arrived in 1947, the shelves were labeled “white blood” and “colored blood.” All the bottles were labeled “colored” or “white.” “Colored” blood was never given to white patients. But in an emergency, white blood was given to black patients.

One employee who began working at the blood bank in 1950 remembered a large blackboard, half of which was painted white and half black, on which the donors’ names were listed in the appropriate space. Black donors were drawn in a separate room from white donors. The employee recalled that blood shipped into Hopkins was not identified by race—except for blood that came from Alabama.

The first black patient was seen in a private outpatient clinic in 1946. The patient’s appointment had been made by letter; no one was aware of his race. Upon discovering the situation, internist James Bordley called Mac Harvey, new director of Medicine, for advice. Harvey told him to see the patient as he would any other.

Little by little, beginning really in the early 1950s, integration took place. Marburg was the first of the inpatient facilities. There were no general announcements or proclamations. In 1956, the admitting office was instructed by the administrator of the private services to gradually implement the change. Three years later, Alfred Blalock, chairman of Surgery and mentor to Vivien Thomas, approved the full integration of the surgical ward services. The Osler nursing units were integrated around 1960. By 1964, only one inpatient service had yet to be integrated: Psychiatry.

The Psychiatric Outpatient Clinic had always provided care to blacks. Those who required inpatient care were referred to a state hospital. The state facilities were segregated. In fact, the state had separate institutions for blacks. Hopkins’ Department of Psychiatry did not accept African-American inpatients in Phipps until around 1968.

The department, however, could lay claim to having the first black physician on the full-time faculty. Earl Nash, a black research scientist in psychotherapy with a Ph.D. from New York University, was appointed to the psychiatry faculty in 1951. He served until his death in 1965.

—Louise Cavagnaro, with Anne Bennett Swingle

A History of Segregation and Desegregation at The Johns Hopkins Medical Institutions, by Louise Cavagnaro, is on file at the Alan Mason Chesney Medical Archives, 2024 E. Monument St., 410-955-3043.