Infectious Fear

Infectious Fear: Politics, Disease, and the Health Effects of Segregation

Samuel Kelton Roberts
Copyright Date: 2009
Pages: 328
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  • Book Info
    Infectious Fear
    Book Description:

    For most of the first half of the twentieth century, tuberculosis ranked among the top three causes of mortality among urban African Americans. Often afflicting an entire family or large segments of a neighborhood, the plague of TB was as mysterious as it was fatal. Samuel Kelton Roberts Jr. examines how individuals and institutions--black and white, public and private--responded to the challenges of tuberculosis in a segregated society.Reactionary white politicians and health officials promoted "racial hygiene" and sought to control TB through Jim Crow quarantines, Roberts explains. African Americans, in turn, protested the segregated, overcrowded housing that was the true root of the tuberculosis problem. Moderate white and black political leadership reconfigured definitions of health and citizenship, extending some rights while constraining others. Meanwhile, those who suffered with the disease--as its victims or as family and neighbors--made the daily adjustments required by the devastating effects of the "white plague."Exploring the politics of race, reform, and public health,Infectious Fearuses the tuberculosis crisis to illuminate the limits of racialized medicine and the roots of modern health disparities. Ultimately, it reveals a disturbing picture of the United States' health history while offering a vision of a more democratic future.

    eISBN: 978-1-4696-0589-0
    Subjects: Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
    (pp. xi-xiv)
  4. INTRODUCTION Disease Histories and Race Histories
    (pp. 1-18)

    In late September 1920, the case of Alice Barnes and her family was referred by the Baltimore Family Welfare Association to the Henry Watson Children’s Aid Society (HWCAS). Soon thereafter, the HWCAS sent its agent, S. S. Lawrence, to Barnes’s residence, a rented room in a “two story, six room house on a broad, smoothly paved street, in a rather nice section of the city” in which Barnes and her two-year-old daughter, Eleanor, had lived for nearly two months.¹ Alice Barnes was aware that she was dying and wantedto make provision through the society for the care of her toddler...

    (pp. 19-40)

    This book is primarily concerned with two overlapping and mutually informative periods in U.S. urban history: the era of infectious fear all but vanquished by the discovery of antimicrobial therapies, and a period, before the Second World War, when health policy and social policy were, comparatively speaking, overwhelmingly dominated by politics derived from local rather than federal mandates. Key to understanding the first half of this equation—the politics of race and tuberculosis in the early twentieth century—is an understanding of the transmission of the disease and the state of medical knowledge during this period. While chapter 2 examines...

  6. 2 THE RISE OF THE CITY AND THE DECLINE OF THE NEGRO: The Historical Idea of Black Tuberculosis and the Politics of Color and Class
    (pp. 41-66)

    Diseases and human endeavors to understand them occur in political and social context. The intellectual history of race and tuberculosis suggests that developments in theory, research, and technology—the discovery of the tubercle bacillus, epidemiological formulations, the development of radiographic and tuberculin screening, the use of autopsy data, and explorations of primary infection—were not separable from changing ideas regarding the roles of heredity and environment in disease or from the massive demographic and economic changes that occurred in U.S. cities between the mid–nineteenth century and the mid–twentieth century. The first question that must begin a historical investigation...

    (pp. 67-86)

    If the politics of freedom, color, and labor influenced medical theories of race and tuberculosis, on the other side of this dynamic were the ways in which spectacularly high rates of disease morbidity and mortality could suggest certain political options while foreclosing others. In short, while this book is concerned with political and epidemiological interpretations of built environment, this chapter shows how in reciprocal fashion the built environment of Baltimore and the disease conditions it produced set the ground on which tuberculosis politics would unfold. The depth of the problem is suggested by comparison of nonwhite and white life expectancies...

  8. 4 ESTABLISHING BOUNDARIES: Politics, Science, and Stigma in the Early Antituberculosis Movement
    (pp. 87-106)

    The larger politics of tuberculosis and the race-labor question described in chapter 2 and regional and local political economy presented in chapter 3 provided the ground on which white health professionals and statisticians racialized tuberculosis in the nineteenth century. Though necessary, these two conditions were not sufficient for race politics to play out the way it did within the antituberculosis movement. The racial stigma that mediated blacks’ inclusion in antituberculosis work also derived in part from the expansion of urban public health, itself a social and political response to urban industrial and population expansion. In the late nineteenth century, public...

    (pp. 107-138)

    After embracing house infection theory, early antituberculosis reformers faced the central and dual problem of strategizing surveillance and of convincingly presenting to the public the utility of the surrender of privacy. This was a novel political challenge in that one did not necessarily presume the other. Several historical precedents existed for tensions between private and individual rights and public health, most notably the issue of quarantine but also the politics of land use, nuisance abatement, and other public health decisions in which surveillance and enforcement were far less widespread and public than that required by the problem of tuberculosis. Tuberculosis...

    (pp. 139-168)

    In a 1903 paper, William Osler interpreted Lawrence Flick’s theory as providing a mandate for the expansion of the public health state, advising all health departments that house infection required house surveillance. Osler in this regard was one of the most vociferous of Flick’s supporters in Baltimore, and by 1904 even private physicians generally had desisted in their public opposition. TheMaryland Medical Journal, an organ of the Medical and Chirurgical Faculty of Maryland, described Osler’s paper as “so scientific, practical and inspiring that it should be read by every physician, especially by those in Maryland.” The realization, highlighted at...

    (pp. 169-200)

    The punch line to Baltimore Health Commissioner John Blake’s opening joke was the apocryphal remark made when a white gentleman offered to pay Rastus and Sambo five dollars each if they could name the “two best things in life.” With little contemplation, Sambo started off, saying, “I think the best thing in the world is a nice, fat, juicy, prepared ‘possum, cooked nice and well done, with fine cornbread. That is the first best thing I can think of in this world, and the next best thing is a nice, juicy watermillion.” Evidently stumped for further answers, Rastus threw up...

  12. CONCLUSION Unequal Burdens: Public Health at the Intersection of Segregation and Housing Politics
    (pp. 201-222)

    A laboratory-centered history of the antituberculosis movement might conclude with the advent of chemical therapies—the development of streptomycin in 1944, followed by para-aminosalicylic acid (1949), isoniazid (1952), pyrazinamide (1954), cycloserine (1955), ethambutol (1962), and rifampicin (1963). Since the discovery of the tubercle bacillus in 1882, physicians had looked forward to the day when tuberculosis could be cured, even eradicated. With good reason, health officials viewed the emergence of these cures as the beginning of the end of tuberculosis. For African Americans, whose tuberculosis burden always had been proportionally higher than that of their white counterparts, chemical interventions promised to...

  13. NOTES
    (pp. 223-298)
  14. INDEX
    (pp. 299-313)
  15. Back Matter
    (pp. 314-314)