The Old Stork: Thomas Boulware delivered healthcare change to Birmingham

Dr. Thomas Boulware

Alabama and Birmingham have had their share of healthcare pioneers:  Senator Lister Hill, Lloyd Noland and industrialist Thomas Hillman all come to mind. But when it came to birthing babies–about 21,000 over 62 years–the honor went to Dr. Thomas Boulware, a Birmingham practitioner accused of promoting “socialized medicine” who brought modern obstetrics to the city’s most blighted black census tracts, the ACIPCO/Slossfield neighborhood in northwest Birmingham.

Boulware (1903-1991) grew up in Hannibal, Mo., graduated from Washington University medical school in St. Louis, and finished his residency at Vanderbilt. As the Great Depression loomed, he was recruited to Birmingham’s Norwood Clinic by hospital founder Dr. Charles Carraway and would soon introduce many of Alabama’s obstetric firsts at Southside’s Hillman charity hospital: The first pregnancy test administered (1929), first “bikini” Caesarean section (1932), and first OB/GYN residency approved in the state (1934).

But it was in the realm of indigent care–mainly to black expectant mothers and their newborns–that Boulware really went the extra mile. Thirty years after Dr. Lloyd Noland battled the spread of typhoid, malaria and tuberculosis in company-owned mining villages, having a baby was still a risky proposition if you were black and lived in certain areas of town. Boulware crossed those barriers, for a time being one of only a few white doctors to deliver babies in black homes, or perform life-saving Caesarean-sections on black mothers in emergency labors.

Boulware, the same doctor who established the first indigent maternity clinic at Hillman in 1935, advocated prenatal clinics for these women despite criticism that he was fostering a form of “socialized medicine.” He was appalled at the conditions at the tiny

A mother, her baby and nurse pose for a 1940s photo to promote the Slossfield maternity clinic. Conditions were bare, but good health prevailed.
(Photo from UAB Archives)

Children’s Home Hospital near Legion Field–the only clinic where black doctors were allowed to practice. He was paid in prayers at the Holy Family Hospital in Ensley, and lamented in professional articles how destitute black mothers–their health often compromised by other issues–did not see doctors unless their pregnancies transformed into emergencies, which they too often did.

As he wrote for a 1943 report in the Southern Medical Journal, “Among the many contributory factors which result in a relatively high maternal mortality rate for the South, professional errors occupy a prominent place. Of equal importance has been a lack of opportunity and facilities to provide adequate maternity care for those who need it most.” (“A Negro Demonstration Center for Maternal and Newborn Care in Alabama,” with Elizabeth LaForge, and R. C. Stewart.)

Nowhere were conditions more extreme than in Slossfield, a district surrounding the American Cast Iron Pipe Co.’s plant, where thousands lived without plumbing, in shotgun houses built on stilts over undrained dirt streets. Seven of the county health department’s 22 “blighted” areas fell in this district, where 8-10 babies died out of every 100 born.

Waiting for the doctor at Slossfield.
(Photo from UAB Archives)

Boulware in the 1930s joined a public health movement that was already gaining steam to relieve Slossfield’s misery. With the help of matching money from ACIPCO, black workers had pooled their earnings to build an athletic field, which was eventually the site of a model community center complex, with a maternity clinic and physician training center.

For seven years Boulware worked at the center’s 12-bed clinic, bent on proving that better prenatal care would improve outcomes for mothers and their babies. His report on the first three years declared the experiment a success: Care at Sloss had cut the stillbirth rate on average from 6% among black mothers countywide to 3.3%, and reduced neonatal deaths by nearly half, from 4.3% among blacks countywide to 2.4%. Of the 1,168 babies delivered in that period, three mothers died, but none from complications of birth.

Meanwhile, his work in training black physicians added another first to his resume. Boulware’s Slossfield protégé, Dr. Robert Stewart, became Alabama’s first “non-white” board certified OB/GYN practitioner–his training fellowship paid by Boulware.

The WPA-built Slossfield complex faces 25th Avenue North in Birmingham on 20 acres once occupied by the city’s municipal stables. It has been closed for more than a half century.

The center was short-lived, and it was closed in 1948. The war had intervened and in a series of twists, Alabama’s own Senator Lister Hill co-sponsored a post-war bill to fund new hospital construction in underserved areas, with provisions to care for poor patients regardless of race. Although Hill-Burton at first permitted segregated wards, it nevertheless rendered segregated facilities obsolete, while securing decades of modernization that benefited the South, and built the medical college now part of UAB.

(Ensley’s all-black Holy Family Hospital, built in 1953 with the blessings and donations of Birmingham business leaders and $500,000 in Hill-Burton funds, was an exception.)

Dr. Boulware, the Old Stork, “hung up his forceps” at this 1977 retirement party. His son presents the instrument on a suitable plaque.

In 1977, “the old stork,” hung up his forceps, donating much of his papers to UAB archives. Recently his son, Tom Boulware, Jr., brought by some of those artifacts to the history center–pictures and two pocket notebooks his father had used to record his deliveries, numbering and listing by each mother’s last name all 1,435 C-sections performed over 48 years.

Dr. Boulware recorded virtually all his deliveries. This little black book contains his Caesarean births, by year.

“He was often accused to trying to promote socialized medicine,” Boulware said. “Nothing could have been further from the truth. He was very proud of his work at Sloss and thought it was his duty as charity and part of the Hippocratic Oath.”

The city-owned Slossfield complex was put on the National Historic Register in 2008, in part due to Boulware’s career there, but remains vacant today.