A once slave-owning state, Tennessee long mandated separate and unequal health care. White hospitals and clinics refused to treat African slaves and free blacks through the Civil War. In 1881, Tennessee passed the first segregation legislation in the postbellum South, a law that required railroad cars separated by race, setting a template for the Jim Crow era. Reconstruction-era discrimination against African Americans by medical schools and teaching hospitals in Tennessee was so extreme that in 1876, black physicians opened one of the nation’s first African American medical schools, Meharry
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