Matilda was the oldest of three children and spent much of the beginning of her life working in fields alongside her family.

She left in 1892 after graduating in 1891 from Oberlin College to accept a teaching position at Haines Institute in Augusta, Georgia.

After a year of teaching Matilda entered the Woman’s Medical College in Philadelphia, again with the help of her resourceful mentor, Schofield, who persuaded a wealthy benefactor, Sarah Corlies, to fund her education.

[5] The Alfred Jones to whom this letter is addressed[6] was Secretary of the Executive Committee of the Board of Corporators of the Woman's Medical College of Pennsylvania.

In the late 19th and early 20th centuries, African Americans seeking a medical education were faced with difficult prospects.

[7] This continued into much of the 20th century, and although some black students were admitted into white medical schools and hospitals, they faced blatant racism, ostracism, and prejudice.

Prevailing notions held women to be too feeble-minded to succeed in the demanding arena of academic medicine and too delicate to endure the physical requirements of clinical practice.

One of the most serious barriers to the success of the college was the lack of clinical experience available to its students and interns because area hospitals would not allow women to attend lectures or to treat patients.

[10] As the first African-American woman licensed to practice in South Carolina, Evans was able to treat both white and black patients, causing her services to be in great demand.

[14] By 1907 Evans was able to write to Alfred Jones, Bursar at Woman's Medical College of Pennsylvania, "I have done well, and have a very large practice among all classes of people...

She was writing to Alfred Jones on behalf of a promising young African-American woman who wanted to attend WMCP but was in need of scholarship assistance.

According to historian Darlean Clark Hine, in an article on Evans which appeared in The Journal of Southern History Vol 70 No 1 Feb 2004, The St. Luke's Hospital which was established by Dr. Evans was located in Columbia, South Carolina and consisted of fourteen rooms and twenty beds, a facility that she operated until 1918.

In 1916 Evans created the Negro Health Association of South Carolina and two years later in 1918 she volunteered in the Medical Service Corps of the United States Army during World War I.

Evans also served as a regional Vice President of the National Medical Association and also established the Negro Health Journal of South Carolina.

Senate Bill 1424, passed in April 1908, granted the US Army authority to set up a reserve body of medical personnel.

[17] Evans ran her own farm like the one she grew up on and founded a weekly newspaper, The Negro Health Journal of South Carolina, and offered a program of recreational activities for underprivileged boys.