There was a long history of slavery in the region that pre-dated American settlement. French settlers brought the first enslaved Africans to Upper Louisiana during the early eighteenth century to work in their mining, trapping, and agricultural ventures. During nearly a century of French and Spanish rule, a complex multicultural and multiethnic society developed in which enslaved people played an important role. Although a few had emigrated in the 1790s, after the United States purchased Louisiana from France in 1803, an influx of American settlers, most hailing from Kentucky, Tennessee, North Carolina, and Virginia, migrated to Missouri in large numbers, many bringing enslaved people with them. The region emerged as a destination for migrants from the Upper South in the years following the political compromise that resulted in Missouri’s admission as a slave state in 1821. By 1850, slaveholders had settled in all Missouri counties, but a vast majority resided along the Missouri and Mississippi Rivers in order to take advantage of the fertile bottomlands and the transportation opportunities provided by the river systems. These southern migrants replicated the diversified farming and small-scale slavery practices of their original backcountry homes, producing wheat, corn, tobacco, hemp, and livestock, for both home use and sale in national and international markets. Plantation slavery never developed in Missouri on a large scale.  As late as 1860, only four percent of Missouri slaveholders claimed 20 or more enslaved people and less than one percent owned 50 or more. With the exception of Delaware, Missouri had a larger percentage of enslaved people living on small-scale slavery operations than any other slave state. 

The demographics of small-scale slavery affected the relationships between enslaved people and those who commanded their labor as well as the family and community experiences of enslaved people. Overseers were rare in Missouri and most slaveholders directly supervised and worked with enslaved people in their homes and fields. The close proximity in which black and white Missourians lived and worked increased the opportunities for them to profoundly influence one another’s lives. In Missouri, as elsewhere, White Missourians had the upper hand in power relations, yet intimate knowledge of enslavers’ personalities provided some enslaved people with the means to resist their authority and in some cases favorably alter their circumstances. But more often, the close living conditions on farms undermined the quality of enslaved people’s lives and exposed them to the worst forms of abuse. Enslaved Missourians enjoyed little privacy and some enslavers directly interfered in their personal lives. Household relations could be volatile, often resulting in violent confrontations and extreme and devastating psychological, physical, and sexual abuse. 

Systemic factors of small-scale slavery in a border state also played a key role in the quality of enslaved Missourians’ lives. Hiring was an important component of the labor market in antebellum Missouri. White Missourians who claimed more enslaved workers than they could profitably employ in their own farms or businesses hired them out to local farmers, manufacturers, and businesses, providing flexible use of their labor force and a source of revenue from workers who otherwise would have been underemployed. It was common for non-slaveholding whites to hire enslaved women and children to work as domestics in their homes as well. In addition, enslaved individuals were hired out when estates were in probate and to provide steady income for widows and minors. Hiring also allowed Missouri enslavers to off-load the expense of clothing, food, and medical care of enslaved workers onto hirers’ accounts.  While hiring assignments might grant enslaved people greater freedom of movement, the opportunity to acquire specialized skills, and occasionally a chance to earn cash through temporary work for white neighbors, hiring more often was a negative experience. Those who were leased were routinely separated from their family members, including young children from their parents, and despite agreements that theoretically protected against abuses, many were worked harder and were treated more harshly. 

The preponderance of small-scale slavery in Missouri worked in other ways to undermine enslaved people’s social interactions with others. Most enslaved Missourians lived on farms with only a few other enslaved individuals, thereby compromising their ability to consistently access crucial support systems, such as a resident nuclear family or a slave-quarter community. The limited availability of potential spouses on most slaveholdings forced enslaved men and women to find partners on neighboring farms. Well over half of marriages between enslaved men and women were cross-farm or “abroad” unions. These unions were not sanctioned or protected by law but they were recognized by the black and white community as marriages.  Husbands and fathers were generally allowed by slaveholders to travel to visit and stay with their families at least once a week, typically on Saturday evenings and Sundays.  Abroad men were challenged to provide for their families emotionally and economically when most spent so little time with them. For much of the week, enslaved women cared for their children’s needs as the primary caregivers, disciplinarians, providers, and protectors. In spite of the limitations, many couples, such as Spotswood and Orry Rice, forged strong family ties that often lasted many years.

Enslaved Missourians also rarely benefited from a plantation slave-quarter community. Some suffered devastating isolation and most had limited access to enslaved individuals outside their own farms on a daily basis, but a vast majority used their little free time to create vibrant social networks within local neighborhoods. In counties with large enslaved populations, people met in town, at church, at work parties or weddings, or when hired out. Enslaved men traveled throughout the countryside, running farm and household errands, working for others, and visiting their wives and children; enslaved women frequently attended religious services at local churches and social gatherings along with men. White Missourians often sanctioned enslaved people’s social interactions with others, understanding that the smooth functioning of slavery and the natural increase of the enslaved population depended upon the viability of abroad slave marriages and inter-farm slave communities. There were frequent work-related “frolics,” such as corn huskings and building raisings, held in the community on many weekends.  These gatherings augmented the size of the limited work force found on most Missouri farms and white Missourians were happy to provide food and a dance in exchange for free labor.  Enslaved people were happy to socialize with friends and neighbors at these events but they understood that their price of attendance was their labor and vigilant supervision from white attendees. Many enslaved people were more interested in socializing on their own terms and they frequently risked running afoul of the local slave patrol by clandestinely meeting in the woods or abandoned buildings for gambling parties or dances.

While the vast majority of Missouri slaves lived in the countryside, enslaved and free blacks were a vital presence in the growing city of St. Louis. The urban setting provided them with opportunities for increased mobility and forging connections with others in the black community. They were employed at a number of occupations in the bustling commercial and manufacturing center, including skilled trades such as blacksmithing, carpentry, or work as a seamstress as was the case of Elizabeth Keckley. Large numbers of free and enslaved blacks also worked on the docks and riverboats that plied the waters of the Missouri, Mississippi, and Ohio Rivers, lending an air of transience to the city’s black population, and also enhancing chances for some to successfully reach free soil. The expansive hiring system also presented opportunities for others, such as Keckley, to earn money for extra work and eventually purchase their freedom.  The large number of free black St. Louisans (in comparison to the rest of the state where their numbers were few) led to the establishment of black-centered churches, schools, and social organizations for the benefit of both free and enslaved people, although their activities were often circumscribed by the surveillance of white residents and laws that forbade teaching enslaved people to read and write. 

During the tumultuous years of the Civil War, enslaved Missourians took advantage of their vast knowledge of the local geography, their astute understanding of the political divisions among White Missourians, and the many family and community connections gained during slavery to bring about their liberation from bondage. Missouri’s traditional ties to the South were transformed in the decades preceding the war as agricultural practices and the railroad increasingly linked the state to the North and as migrants from free states and European nations, some who opposed slavery, moved into the state in the 1840s and 1850s. The end result was deep political divisions in the state during the Civil War. The residents of Missouri found themselves in the cross hairs as Union troops occupied the state and a Confederate guerrilla insurgency emerged to counter it.  Ultimately, tens and thousands of Missouri’s nearly 115,000 enslaved individuals fled to nearby Union army encampments, into the state’s urban areas, or to nearby free states to seek protection from the violence that permeated the countryside.  After 1863, enslaved men enlisted in the Union army in high numbers. The efforts of enslaved Missourians dealt a fatal blow to slavery in the state long before a Republican-dominated constitutional convention legally ended slavery in January of 1865.

Homer G. Phillip’s history begins with the first calls to better Black healthcare in St. Louis. In the early 1900s, African American patients faced discriminatory care at City Hospital No. 1, where they were often turned away or committed to an overcrowded segregated ward. At the same time, few residents could afford care offered by private Black physicians who operated at a higher cost with limited space. In 1914, a committee of seventeen Black physicians implored the mayor to recognize the lack of training opportunities and inadequate facilities for African Americans at City Hospital No. 1.³ City officials responded by purchasing the abandoned Barnes Medical College for $87,000 and renovating the facility to care for St. Louis’ 70,000 Black residents. Opened in 1919, the 177-bed medical center became known as Hospital No. 2.⁴

Within a few years, City Hospital No. 2 became inadequate to meet the growing demand of the African American population. In 1923, local attorney Homer G. Phillips led a campaign to acquire a civic improvements bond issue for the construction of a larger hospital. He claimed that since City Hospital No. 2 was built, the Black population had grown considerably due to continuous migration to St. Louis from rural Missouri and the South. The bond issue was passed for 87 million, with one million slated to fund a new hospital.⁵ The city refused to allocate the funds toward the construction of the hospital, arguing that a separate and independent facility for Black patients was completely unnecessary. Instead, they suggested adding a white-run annex for African American patients to Hospital No. 1.⁶

Although morally opposed to segregation, Phillips understood that Black doctors and patients could not receive equitable care or training at Hospital No. 1, where they faced exploitation at the hands of white doctors. Thus, he argued against the annex proposition and pushed for the separate hospital plan to move forward. Over the next decade, Phillips fought alongside other groups like the Colored Committee of the St. Louis League of Women Voters, until 1932, when the ground was finally broken for the construction of the Homer G. Phillips Hospital.⁷ Unfortunately, Phillips would never see his dream realized as he was tragically killed the year before. The circumstances of Homer G. Phillips tragic death remain contested. In the morning hours of June 18, 1931, 51-year-old Phillips, left his home to wait for the streetcar. According to a witness account, Phillips was approached by men who shot him 6 times. Two teens were eventually arrested and tried for his murder, but the jury found them not guilty. Many theories exist as to why Phillips was targeted, all of which are overshadowed by the reality that the police never solved the crime.⁸

Homer G. Phillips was dedicated in the morning hours of February 22, 1937.⁹ Designed by architect Albert A. Osburg, the Hospital was constructed for 3.16 million dollars in an H form with art deco features.¹⁰ The seven-story medical center had a central administration building with four wings extending from its core. Facilities included an additional service building and a nurses’ home with accommodations for 146 nurses and 24 interns. ¹¹ With 685 patient beds, Homer G. Phillips became the largest and most equipped Black-run, Black-serving hospital not only in Missouri but in the country. In its first year of operation, the hospital served 100,000 patients.¹²

Located at 2601 Whittier Street in the Ville, Homer G. Phillips quickly became a pillar of St. Louis’ Black community. Just northwest of downtown, the Ville was a residential, business, and cultural center for Black St. Louisans. At its peak, the hospital created nearly a thousand jobs for physicians, nurses, aides, ambulance drivers, and other workers living in the area.¹³ Alongside the Sumner High School, Antioch Baptist Church, Annie Malone Children’s Home, and other Black-run businesses, the hospital fostered stability in the Ville during the years of segregation.¹⁴

Homer G. Phillips Hospital also became the premier hospital for teaching Black physicians in the region. For over 20 years, 75% of African American doctors in the United States were interns at Homer G.¹⁵ Helen Elizabeth Nash, a former intern, recalled, “Well everybody came to Homer G. It was one of the best places. They took the largest number of interns, and you could be sure of getting a residency.”¹⁶ After receiving training at the hospital, Nash became the first Black woman on the pediatrics staff at St. Louis University and an activist for African American healthcare.¹⁷ Like Nash, many Homer G. Phillips graduates went on to have successful careers at renowned institutions at a time when discrimination prevented Black and women physicians from holding high-ranking positions.

Alongside doctors, the hospital trained nurses and other medical professionals. One nursing student, Lula M. Hall, came from Little Rock, Arkansas to study at Homer G. Phillips. After graduating from the hospital’s nursing program in 1959, she worked as an acute and psychiatric nurse in St. Louis until her retirement in the 1990s.¹⁸ Before the last graduation of nursing students in 1968, the hospital had trained hundreds of nurses like Hall. The hospital also had laboratory and x-ray technician programs and educated foreign doctors who were denied training at other hospitals because of their race or ethnicity.¹⁹

Homer G. Phillip’s leadership extended to quality patient care. By 1945, the hospital ranked in the top 5 largest general hospitals.²⁰ Over the next two decades, the hospital led the development of the practice of intravenous feeding and treatments for ulcers, burns, and gunshot wounds.²¹ The hospital also saw gains in infant care.

For all its successes, the hospital still faced unfair and discriminatory funding which negatively impacted the institution. The Comptroller’s Department did not afford the hospital the same funding as Hospital No. 1, and many departments at Homer G. Phillips were not in control of their own finances. These conditions led to supply shortages, loss of appropriated funds, and insufficient wages for physicians, nurses, and staff.²² As a result, the hospital struggled to recruit medical students, ultimately ushering a decline in the quality of care.

Homer G. Phillips experienced radical changes in mid-twentieth century. Rising costs had spurred St. Louis Mayor Raymond Tucker to order that city hospitals desegregate in 1955, a decision that effectively signaled the end of an era for one of the most successful Black hospitals in the United States.²³ In the fall of 1964, newspapers began reporting that the city intended to relocate departments and possibly close Homer G. Phillips. After a 15-year fight to keep the hospital open, Mayor Vincent Schoemehl and Judge James Conway mandated Homer G. Phillips close and transfer its departments to Hospital No. 1 in 1979.²⁴ Community members protested the hospital’s closure, citing cultural significance and the continued need for a medical facility to treat Ville residents. The protests were unsuccessful, and Homer G. Phillips operated only as an outpatient and emergency care unit until 1985.²⁵

Despite its closure, Homer G. Phillips Hospital remains one of the best examples of Missouri’s segregated hospitals. At times, Homer G. Phillips Hospital was among the best Black-run, Black-serving medical centers in the nation. The care that African American patients received was far better than they could access at most public hospitals, and the educational opportunities afforded to Black doctors, nurses, and staff were innumerable. Nevertheless, care and education were never entirely equal due to the limitations of segregation.    

Homer G. Phillips was not the only segregated hospital in Missouri, but rather part of a network of Black serving facilities across the state. In 1924, Kansas City’s General Hospital No. 2 became the first public hospital in the United States to be staffed and operated solely by African Americans. Six years later, a new General Hospital No. 2 opened in the city and became one of the nation’s most equipped segregated hospitals for the treatment and training of African Americans.²⁶ Black-run medical facilities emerged in Missouri’s other cities, such as the Bartley-Decatur Center in Springfield, Wheatly-Provident in Kansas City, and General Hospital No. 2 in Sedalia. Although smaller, these hospitals were equally essential to providing equitable care for their respective communities during years of segregation.

Like Homer G, these hospitals were never given the same financial and technological resources as white-only hospitals, and their success rested heavily on corrupt politics and external factors. For all their achievements, segregation still limited these important institutions.