REVIEW

Crooked Path Made Straight: The Rise and Fall of theSouthern Governors’ Plan to Educate Black PhysiciansRichard D. deShazo, MD,a Keydron K. Guinn, PhD,b Wayne J. Riley, MD,b William Winter, JDcaUniversity of Mississippi Medical Center, Jackson; bMeharry Medical College, Nashville, Tenn; cJones Walker Law Firm, Jackson, Miss.

Funding: NonConflict of InAuthorship: A

manuscript.Requests for r

Department of MeN. State Street, Ja

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0002-9343/$ -seehttp://dx.doi.org/1

ABSTRACT

In 1945, a wave of GI-Bill-supported African American students, qualified for admission to medicalschools, returned from their service in World War II. The possibility that their acceptance would integrateall-white medical schools was a problem for the southern governors. The governors responded witha carefully considered plan to shunt these African American applicants to historically black medicalcolleges by joining in a Compact and attempting to purchase Meharry Medical College in Nashville,Tennessee. This untold story of American medicine and its connection to our present shortage of AfricanAmerican physicians in the South needs to be remembered and passed on to future generations.� 2013 Published by Elsevier Inc. � The American Journal of Medicine (2013) -, ---

KEYWORDS: African Americans; History; Medical school

THE MEETING AT WAKULLA SPRINGSA meeting of the Southern Governors’ Conference wascalled in Wakulla Springs, Florida on February 7, 1948.1

Present were a powerhouse of white southern politiciansincluding Jim Folsom of Alabama, Jimmie Davis of Loui-siana, Millard Cauldwell of Florida, R. Gregg Cherry ofNorth Carolina, and Strom Thurmond of South Carolina,with their lieutenant governors and entourages. The gover-nors were on an urgent mission to sign an agreement thathad been years in the making. Now, the South would haveits own medical school for African Americans: MeharryMedical College in Nashville, Tennessee (Figures 1, 2).2

PRESSURE AND PLANNINGOnly a decade earlier, the United States Supreme Court hadopened the all-white University of Missouri Law School toAfrican Americans on the grounds that the state-supported,out-of-state study they provided was not equivalent to that

e.terest: None.ll authors had access to the data and a role in writing the

eprints should be addressed to Richard deShazo, MD,dicine, University of Mississippi Medical Center, 2500ckson, MS 39216.: rdeshazo@umc.edu

front matter � 2013 Published by Elsevier Inc.0.1016/j.amjmed.2012.11.033

afforded white law students in-state.3 This ruling threatenedthe existing segregation in state institutions of higherlearning perpetuated by the “separate but equal” ruling inthe 1896 US Supreme Court decision in Plessy v Ferguson.4

And now, as African American troops returned home fromWorld War II, and the financial support of the GI Billbecame available, pressure for admission of blacks to attendsegregated state universities was increasing.

Historically, many southern states had provided “schol-arships” to traditionally black institutions for AfricanAmerican applicants to state professional schools in order topreserve segregation in their all-white institutions. Forinstance, the Committee of Southern Regional Studies andEducation of the American Council of Education had anarrangement for “student exchange programs.” The gover-nors knew the committee’s part-time executive secretary,Dr John E. Ivey, Jr.1

Medical education was an increasing concern, as therewere few black medical professionals and fewer interestedwhite ones to care for black patients. There were ongoingconversations among the governors of southern states aboutthe use of Meharry Medical College in Nashville as a fee-for-service “regional center for Negro education.” Meharry, aMethodist-affiliated institution, was established and runby well-intentioned white businessmen to educate blackmedical professionals to care for black patients. Financesthere were a chronic problem. As early as September 1943,

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then-Meharry President, Dr E. L. Turner, met with electedrepresentatives from Alabama, Georgia, Louisiana, NorthCarolina, and Tennessee about “scholarship” support asa revenue stream.5 Meharry’s predominately white Board ofTrustees approved ongoing discussions in October 1943 andnoted that a scholarship arrangement was already in place

CLINICAL SIGNIFICANCE

� Racial segregation was common inSouthern medical schools before WorldWar II.

� African American soldiers returning fromthe war had earned the right to advancededucation through the GI Bill. This pre-sented a problem to Southern politicianswho wanted to maintain segregation.

� There are several possible reasons for theshortage of physicians in America, andMississippi in particular. Racial segrega-tion and manipulation of medical schoolenrollment by African Americans mayhave played a role in today's shortage.

with the State of Tennessee.6 At the1945 meeting of the SouthernGovernors’ Conference, GovernorsChauncey Sparks of Alabama andMilliard Caldwell of Florida pro-posed a region-wide scholarshipprogram to provide out-of-statemedical training for AfricanAmerican professional students.Later, at a December 5, 1946Southern Governor’s Conferencemeeting, Governors Sparks andGreg Cherry of North Carolina,leaders among the governors in themovement for “regional educa-tion,” noted that their states alsohad an active arrangement withMeharry for education of blackmedical students. Virginia hadsimilar contracts with Meharry inthe 1940s.7 The most outspoken of

the segregationist governors attending the 1945 meeting,Thurmond from South Carolina, was quick to support the1945 motion to move forward on a regional plan.1

EXIGENCYThe governors’ plans for “regional education” were threat-ened when they learned that Meharry’s dire financial statuswould force it to close at the end of the 1947-1948 academicyear. A quick solution to prevent that closure would be ofmutual benefit to the governors and to Meharry in theirexigency.1 “Regional education,” as the governors saw it,would not only prevent desegregation of their state medicalschools by sending blacks qualified for medical school out of

“WHEREAS, Meharry Medical College of Nashville,Tennessee, has proposed that its lands, buildings, equipment, and the net income from its endowment be turned over to the Southern States, or to an agency acting in their behalf, to be operated as a regional institution for medical, dental and nursing education upon terms and conditions to be hereafter agreed upon between the Southern States and Meharry Medical College; which proposal, because of the present financial condition of the institution has been approved by the said States who are parties hereto.”2 —Secondparagraph of the Regional Compact as Amended

Figure 1 Compact section transferring ownership of MeharryMedical College to the “Southern States.”

state but would facilitate access for whites to professionaleducation in dentistry, medicine, podiatry, optometry, andveterinary medicine not available in some states—and thesecond arrangement was good cover for the first one. Acoordinated process would be easier to implement than theexisting piecemeal state-by-state approach and provide

a more predictable revenue streamfor a participating black medicalinstitution. Equally important, thiscooperative plan could function asamuch-neededwork-around for theGaines decision. Saving Meharry,a school that then provided half ofthe positions for African Americanmedical students in the US, alsowould be a public relations bonus.

Because Meharry’s financial sit-uation was so acute, a committee ofthe southern governors had visitedthe Meharry campus on January17 and 18, 1948 to receive an as-tounding offer. Meharry’s leader-ship not only agreed to reserve seatsin the medical school for studentssponsored by the Southern Gover-nors’ Conference, but offered toplace the entire institution in

the hands of the southern states.1 Somehow, news of this offerleaked out, and by January 19, The New York Times publisheda story titled, “Medical College Offered to the South.”8 ByFebruary, Dr Don Clawson (Figure 3), Meharry’s white Pres-ident, and the Executive Committee of Meharry Board ofTrustees had reviewedand approved arrangements for a transferof the property, endowment, and administration of Meharry tothe Southern Governors acting through a “Board of Control forSouthern Regional Education.”9

SIGNING THE COMPACTWith Meharry’s fate hanging in the balance, the governorsconvened at Wakulla Springs on February 7, 1949. OnFebruary 8, the “Compact” was signed by the 16 governorspresent from southern and border states (Alabama, Arkan-sas, Delaware, Florida, Georgia, Kentucky, Louisiana,Maryland, Mississippi, North Carolina, South Carolina,Oklahoma, Tennessee, Texas, Virginia, and West Virginia),and immediately ratified by the legislatures of South Caro-lina, Mississippi, and Louisiana.2 By July 1949, it had beenendorsed by the legislatures of all 16 member states.1 Itappeared that the southern states had succeeded in a “sepa-rate but equal” arrangement that skirted Gaines v Canada.

PUSH BACKAlthough President Clawson publicly asserted that theCompact was the only possible solution for the institution’ssurvival, criticism from Meharry alumni, faculty, andnational black physician leadership quickly developed. The

Figure 2 The Meharry Medical Campus, circa 1933. The building on the left is HuldaLyttle Hall. The first entrance of the building on the right leads to the dispensary. Thesecond entrance on the right opens into the old "George W. Hubbard Hospital," named afterMeharry’s first President. These buildings still stand on Dr D. B. Todd, Jr. Blvd. inNashville, Tenn.

deShazo et al A Medical School for Southern Blacks 3

Meharry administration received a telegram from 18 SanFrancisco Bay alumni in classes from 1922 to 1947 whocontended that “the soul of one half the Negro medicalprofession” had been sacrificed at the “altar of whitesupremacy.” They suggested that the southern states “build

Figure 3 Don Clawson, DDS—Meharry’s President from1945 to 1950.

their own Jim Crow institutions, but let Meharry be free ofpolitical entanglements.”10

W. Montague Cobb, MD, PhD, an African Americanfaculty member at Howard University School of Medicinewho served on the National Medical Committee of theNational Association for the Advancement of ColoredPeople (NAACP), had written a widely read monograph onthe education of black physicians, published by the NAACPin 1948.11 That book bemoaned the struggle of AfricanAmericans to obtain medical education at the 75 existing USmedical schools. He reported that Nashville’s MeharryMedical College and The District of Columbia’s HowardMedical School were producing the majority of US AfricanAmerican physicians—about 140 a year, and only 12 or soAfrican American physicians graduated from other USmedical schools. He also lamented the limited opportunitiesfor postgraduate medical education of African Americanphysicians in inner city, “hand-me-down medical ghettos.”Only 25 of the 112 hospitals for African Americans in theUS were accredited. Of those accredited, only 14 hadapproved internships.

The signing of the Compact with the southern governorsprompted Dr Cobb to quickly write a second monograph toaddress the formation of the Southern Regional EducationBoard as the administrative arm of the Compact(Figure 4).12 In the 1949 monograph, also published by theNAACP, he stated that the real reason to pursue “theregional idea” was to escape the 1938 Gaines ruling and themore recent Supreme Court ruling of January 12, 1948 onthe Sipuel case. There, the State of Oklahoma was requiredto open admission for qualified blacks in the state to its all-white state law schools.13 He concluded, “The South is lessable than other sections to afford one good educationalsystem, much less two. In this attempt, “Whites as well asNegroes suffer.”

“We do not find the Southern Governors’ Conference recognizing the long time injustice and their responsibility to their Negro populations byopening the doors of their 26 medical schools and bolstering Meharry as a training institution for doctors of any complexion. Instead, we see the deplorable spectacle, on one hand, of an offer to keep Meharry alive by trying to take the South’s responsibility for training Negro medical professionals off its hands and perpetuate traditional discrimination, and on the other hand, of the Meharry Trustees offering the school as anoutright gift.” Montague Cobb, MD, PhD

Figure 4 Dr Montague Cobb's 1949 assessment of theSouthern Regional Compact.

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WHAT WERE THE ORIGINS OF THE SOUTHERNGOVERNORS’ CONFERENCE, THE BOARD OFCONTROL FOR SOUTHERN REGIONALEDUCATION, AND THE SOUTHERN REGIONALEDUCATION BOARD?The Southern Governors’ Conference, now the SouthernGovernors Association (SGA), was founded in 1934 and isthe oldest and the largest regional governors’ association.The SGA was formed to promote the common interests ofthe governors, including diversification of the South’sheavily agricultural economy by expansion of opportunitiesfor higher education.

The 1948 Compact established the Board of Controlfor Southern Regional Education, which quickly becameknown as the Southern Regional Education Board (SREB),an extension of SGA. The SREB functions today as anonprofit, nonpartisan organization to improve public pre-K-12 and higher education.14 Dr John E. Ivey, Jr.,mentioned previously, became its first director in April of1948.

Today, the SREB works with elected state leaders,schools, and educators to improve academic achievementat all levels of education. The SREB currently sponsors 3educational programs: the SREB Regional Contract Pro-gram, the SREB Academic Common Market, and theDoctoral Scholars Program.15 The SGA’s gubernatorialmembership grew from 5 governors in 1934 to 18 in 1969.In an effort to create a national presence, the organization’soffices were moved from Atlanta, Georgia to Washington,DC in the early 1980s.

A FAILED CONGRESSIONAL JOINT RESOLUTIONOF SUPPORTIn an attempt to dampen criticism of the compact, thesouthern governors facilitated the introduction of SenateJoint Resolution 191 in support for the Compact in the USCongress by 27 mostly southern senators in February of

1948.16 Senator Wayne Morse of Oregon led the oppositionto the resolution and declared that the process wouldprovide opportunities for states to work around federaleducational mandates using a shell game outside of stateboundaries. Other opponents said that the SouthernGovernors’ Conference wished to “preserve MeharryMedical College as a segregated institution for Negroes—a sort of Siberia of medical education to which Negroesapplying to white medical schools might be sent in the hopethat similar arrangements might be made in other fields.”1

The joint resolution was referred to committee and neverreappeared. The SREB responded that the compact neverneeded approval of Congress anyway, as “Under theCompact Clause of the US Constitution, compacts must beconsented to by legislators, but by custom and judicialinterpretation, interstate compacts in areas traditionallyreserved for state powers may function without congres-sional assent, although presumably not in the event ofexpressed disapproval by Congress.”1 Implementation ofthe compact proceeded.

THE EXPECTED, THE UNEXPECTED, AND ESTHERMCCREADYThe new regional organization (SREB) began operation onschedule in 1949. In that year, one expected and 2 unex-pected events occurred. As expected, Meharry and HowardUniversity (the only black medical schools operative at thetime) signed SREB-sponsored contracts for 149 AfricanAmerican, out-of-state students to matriculate at theirinstitutions in medicine and related fields. Nine whiteinstitutions signed SREB contracts for 211 out-of-statewhite students to matriculate at all-white institutions.17

Among these was a SREB contract between the state ofMaryland and Meharry to train nursing students fromMaryland; that marked a sentinel event in the SGA’ssegregation strategy.

Second, Esther McCready, a black woman from Mary-land, applied to the School of Nursing at the University ofMaryland and was rejected and simultaneously offered statesupport to attend Meharry School of Nursing. Unexpect-edly, McCready sued the state and Governor WilliamPreston Lane Jr of Maryland for admission to the Universityof Maryland on a claim of discrimination. Maryland repliedthat provisions for the education of African AmericanMaryland residents in nursing existed in a contract betweenthe SREB and Meharry Medical College and that shouldsuffice, as it was separate but equal.

Third, to great surprise, the SREB asked Lane to with-draw his state’s defense of the McCready case on thepremise that his defense strategy would endanger futureactivities of the SREB and “introduce racial politics” there,an oxymoron.14 Governor Lane refused to change Mary-land’s position. As a result of that refusal, the SREB joinedthe suit against Maryland as a friend of the court on theplaintiff’s (McCready’s) behalf.1 The Board maintained thatthe compact and contracts were not for the purpose of

deShazo et al A Medical School for Southern Blacks 5

avoiding responsibilities “under the existing state andfederal laws and court decrees.” The details of the internalbattle that surely took place at the SREB to take sucha position when there was clear evidence that the SREB hadbeen established to protect segregation, have not beenuncovered despite our efforts to do so.

Maryland won the McCready suit in Baltimore City Courtbut lost in the Maryland Court of Appeals in April of 1950.The Appeals Court’s ruling made it clear that the southernstates could not use the old mechanism they had used fordecades and now had formalized in the compact to denyblacks admission at white state institutions.18 Shortly there-after and for the first time, representatives from participatingblack institutions were given seats on the SREB.

Figure 5 Harold D. West, MD—Meharry’s first AfricanAmerican President. Served from 1952 to 1966.

WHAT HAPPENED TO THE COMPACT, MEHARRY,AND THE SREB?The details of what happened between Meharry and theSREB after the compact was signed in 1948 and theMaryland Court of Appeals Ruling was made in 1950, arescant. At the meeting of the Executive Committee of theMeharry Board of Trustees on March 17, 1950, a “Policy onAdmissions” was approved to “give preference to applicantsfrom the southern area.”19 Meharry President Don Clawsonresigned the same year at the age of 50 and after only 5years as president. Between 1950 and 1952, an InternalManagement Committee of the Board of Trustees headed byDr Robert A. Lambert, formerly Assistant Medical Directorof the Rockefeller Foundation, led Meharry. There werefrequent visits to Meharry by SREB Executive DirectorJohn Ivey, Assistant SREB Director McGlothlin, and othersfrom the SREB as recorded in the minutes of the ExecutiveCommittee of the Meharry Board of Trustees. In the origi-nal Compact negotiations, President Clawson had requiredthat the SREB “guarantee $300,000 annually to MeharryMedical College.irrespective of quota fulfillments.” Inother words, no matter how many contracts for studenteducation were approved each year, Meharry would receive$300,000.20 Indeed, the Executive Committee’s minutes of1951 budgeted a SREB contribution of $300,000 plusa $10,000 Tennessee subsidy for “non-quota” students.21

Those funds from the SREB helped keep the school openwhile financial policies were created to provide a temporaryremedy for the exigency.

We could find only one report of what happened to theSREB-Meharry administrative relationship, as this infor-mation was not included in the minutes of the MeharryBoard of Trustees or the minutes of the SREB. The SREBclaimed that the reason the organization never took controlof Meharry was “it became increasingly obvious that thenew agency was hardly in a position to assume direction ofa medical school, especially one so loaded with political andsocial, as well as educational and financial problems, as theNegro institution in Nashville.”1 Coupling their claim withclear expressions of Meharry’s alumni opposition andunrest, as well as the well-articulated positions of such

leading African American physicians as Dr Cobb andnumerous black medical and civic organizations, theSREB’s Meharry Plan met its demise. It was replaced in the1960s by a more traditional capitated-scholarship programfor the education of black professional students.

In 1952, the Meharry Internal Management Commit-tee appointed the institution’s first black president,Dr Harold D. West, who served in that capacity until 1966(Figure 5). In 1968, a majority of Meharry’s first-year classwas still set aside for black students from SREB states.22

However, support from the SREB was inadequate toaddress ongoing financial problems and by 1982, Meharryfaced loss of accreditation. A $55.6 million governmentalappropriation was made to Meharry by President RonaldReagan that year. In 2008, there were still 25 student slotsreserved in the Meharry Medical College for SREB-spon-sored students who received $24,750 annually during theirmatriculation.23 Today, contracts with the SREB throughthe SREB Regional Contract Program remain part of theMeharry budget and contribute more than a million dollarstowards student support for education in the areas ofmedicine and dentistry.

DID THE ESTABLISHMENT OF THE SREB PLAYA ROLE IN SLOWING GROWTH OF THE NUMBEROF BLACK PHYSICIANS IN THE US?It is clear that the southern states continued to use the SREBsystem to procure slots in out-of-state, traditionally black

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educational institutions well into the 1970s, when blackmedical students began to be admitted to state medicalschools. This was despite the 1950 US Supreme Court deci-sion in Sweatt v Painter, a ruling that should have been thedeath knell of separate but equal in professional education.24

It is reasonable to conclude that arrangements madebetween the southern states, the SREB, and the participatingmedical schools not only slowed the integration of statemedical schools in the South but also contributed to theongoing shortage of black physicians in the US. Funding formedical education through the SREB functioned as a quidpro quo to encourage black applicants to medical school notto pursue admission to their state medical schools in thesouth. On the other hand, the SREB arrangement didprovide opportunity and financial support to attend medicalschool for black students from states where later federalintervention was subsequently required to ensure theiraccess. Now that open admission policies are in place in allstates, SREB scholarships facilitate medical education forstudents who otherwise might not be able to afford thetuition costs associated with a medical education. Thus, thiscrooked road has been made straight. Nevertheless, how thecurse of racial discrimination in the US has contributed tohealth disparities in our country, and the efforts to whichsouthern leaders were willing to go to preserve it, must betaught and remembered.

ACKNOWLEDGMENTThe authors wish to express their appreciation to LeighBaldwin Skipworth, BA, Program Administrator, Universityof Mississippi Medical Center, for her assistance in the prep-aration of this manuscript, and to reference librarians HelviMcCall, MLS, Rowland Medical Library at the University ofMississippi Medical Center, Jackson, Miss and Christine M.Douglas,MLIS,MeharryMedical College Library,Nashville,Tenn for their research assistance on this paper. The assistanceof Mr Mark Musik, President Emeritus of the SouthernRegional Educational Board, also is appreciated.

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