Country doctors, practicing across vast geographic areas with limited resources, were capable practitioners who had often trained at good medical schools and who brought genuine expertise to their communities.

But they were also operating under constraints that urban physicians did not face: limited access to hospital facilities, no colleagues nearby for consultation, the necessity of making difficult diagnostic and treatment decisions alone.

For Black patients in the South during the Jim Crow era, the constraints were even more severe.

The system of segregated medical care that existed throughout the South limited Black patients’ access to the most skilled physicians and the best-equipped facilities.

In many communities, Black patients were treated by a single Black physician (when one existed) or by whatever white physician was willing to serve them (under the paternalistic conditions of the segregation system).