Down and out in old J.D.: Urban public hospitals, institutional stigma and medical indigence in the twentieth century

In 1925 the city of Houston and Harris County opened Jefferson Davis Hospital, a jointly funded public hospital. Less than fifteen years later, a second hospital was built with New Deal funds to replace its overcrowded predecessor. The modern looking Jeff Davis Hospital served as the city-county hospital from 1938--1963. After relocating to Houston in 1943, Baylor College of Medicine eventually assumed professional control of the hospital provoking a lengthy town-gown battle with the Harris County Medical Society. Distinguished by the success of the medical school, but also by its poor funding and deplorable conditions, Jeff Davis embodied the duality in the modern public hospital's identity. Its patients were poor minorities and the hospital was obsolete, dirty, overcrowded and infested with cockroaches. Yet, it was also a site of unprecedented medical innovation in the fields of infectious disease, cardiothoracic surgery and emergency medicine. In 1958 an epidemic of staphylococcal infections caused over thirty deaths in the hospital's nurseries. The epidemic received national publicity and sparked public demands for reform. While local authorities recognized the need for a bigger hospital and more funds for its operation, the public had regularly refused to support improvements that might raise taxes. Jeff Davis Hospital stood in stark contrast to Houston's prestigious Texas Medical Center located four miles to the south and, for much of its history, it seemed Houstonians were content to keep it that way.The distinctions in the American two-tiered system of private and public hospitals became more profound as a result of the development of modern hospital-based medicine and the growth of the twentieth-century medical marketplace. Public hospitals continued to serve their traditional role as places of last resort for the medically indigent, but gained greater importance as teaching hospitals became integral partners to medical education. Despite the high quality of specialty medicine and technology found in teaching hospitals, public hospitals often remained tainted by the stigma of their almshouse origins and American attitudes toward indigence. In the twentieth century, urban public hospitals represented the crossroads of modern medicine, capitalism, medical education and nineteenth-century notions of poverty.