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

1. Toward a Historical Epidemiology of African American Tuberculosis

Baltimore’s Negro death rate is nearly twice that which obtains among the white population. . . . In this simple statement is seen the result of conditions against which serious protest has been and will continue to be lodged by all who appreciate their significance. Poorly constructed houses of bad design, and in need of repair, streets and alleys with defective drainage, congested living conditions . . . are some of the factors which prevent the Negro from attaining the standards of health which the white race reaches without difficulty. In large measure they are beyond the power of the Negro to remedy. He must usually wait for the landlord to build his houses. He certainly must wait for the city to drain the streets in the districts where he lives and to open up highways through the dense settlements where he is now crowded. —Baltimore Sun, 4 February 1925 ∞ t o wa r d a h i s t o r i ca l e p i d e m i o l o gy o f a f r i ca n a m e r i ca n t u b e r c u l o s i s 20 Toward a Historical Epidemiology T his 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 the historical frame of tuberculosis—its popular and medical understandings as ‘‘disease of civilization’’ and the shifting terrain of national racial politics—this chapter explains that elevated rates of mortality and morbidity among African Americans derived largely from conditions of living and from certain populations’ time of infection, themselves the products of shifting ecological imbalances between rural and village hinterlands (sending societies) and emerging urban industrial spatial orders (receiving societies). Although five types of tuberculosis afflict animals, only two, human and bovine, may actually cause the disease in the human body. Humans may contract the bovine form through the ingestion of bovine tissue or cow’s milk in which the bacillus is present. After the turn of the century, however, and particularly after the implementation of milk-purification regulation, most human tuberculosis was caused by the human form of the bacillus, the mycobacterium bacillus, or M. tuberculosis. Most often, M. tuberculosis originated with inhalation, producing pulmonary tuberculosis. Once the bacillus is introduced into the human body and allowed to reproduce , it may attack any organ and spread to others, causing tuberculosis to develop into one or more forms. Particularly when the bacillus is ingested, the disease may manifest itself in the abdominal lymph nodes and the small intestine. It then becomes the clinical condition tabes mesenterica, recognizable by the symptoms of abdominal pain, nausea and vomiting, and diarrhea (probably the condition to which young Archer Barnes succumbed).∞ Tuberculosis of the joints and bones most often affects children, particularly those who are unable to fight off their first, or ‘‘childhood,’’ infection. This form may be less debilitating than pulmonary tuberculosis or the associated disease of kidney and bladder tuberculosis and today is more easily treated. If not treated, however, the disease will literally gnaw away at bone tissue, causing osteomyelitis. From internal organs, infection may spread to the skin (tuberculosis is not communicable by epidermal contact), causing lupus vulgaris (Latin for Toward a Historical Epidemiology 21 ‘‘common wolf’’), in which discolored nodules appear across the victim’s body and especially the face. These nodules grow slowly but eventually will cause the ulceration and destruction of the skin itself, leading to other infections . Much worse is tuberculosis of the spine (known as Pott’s disease after surgeon Percival Pott [1714–88]). Before the urbanization and industrialization of the nineteenth century and the subsequent rise of the pulmonary form, Pott’s disease was one of the more common manifestations of tuberculosis . It left its victims with hunched backs resulting from abscesses in one or more vertebrae, the softening of which eventually could...