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

3. Urban Underdevelopment, Politics, and the Landscape of Health

Particularly with regard to consumption it must be remembered that Negroes are not the first people who have been claimed as its peculiar victims; the Irish were once thought to be doomed by that disease—but that was when Irishmen were unpopular. —W. E. B. Du Bois, The Philadelphia Negro, 1899 ≥ u r b a n u n d e r d ev e l o p m e n t, p o l i t i c s , a n d t h e l a n d s ca p e o f h ea lt h 68 The Landscape of Health I f 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 in the United States, which were 31.3 and 49.1, respectively, in 1905; 38.9 and 55.1 in 1915; 45.7 and 60.7 in 1925; 53.1 and 62.9 in 1935; and 57.7 and 66.8 in 1945. Only after 1950, when local public health departments made antibacterial treatments for infectious diseases (particularly streptococcal, meningococcal, staphylococcal , and bacillus-caused diseases) widely available, did the gap between the two groups begin to narrow. In 1950, nonwhite and white life expectancies reached 60.8 and 69.1; in 1960, they were 63.6 and 70.6; and in 1970, they were 65.3 and 71.7.∞ The other side of this comparison was the difference between black and white rates of mortality. In Baltimore, for example, the ratio of black/white mortality from all causes reached its lowest level in the 1890–1910 period in 1892, when it was 1.37, and peaked at 2.20 in 1904, when the colored death rate was 324.0 per 10,000 population and the white rate was 147.2.≤ As late as 1925, Baltimore’s total mortality was 146.3 per 10,000 population, but the differential between whites and blacks slightly exceeded 120 persons per 10,000 population (12.84 versus 24.89, respectively).≥ During 1912–16, deaths exceeded births among Afro-Baltimoreans by 2,373 (a population loss of 2.68 percent, excluding migration), while white births exceeded deaths by 15,277 (an increase of 2.99 percent).∂ The pre-1950 disparity in mortality resulted largely from a set of infectious conditions, including tuberculosis, whose incidence was known to derive from poor living conditions. Three in particular—typhoid fever, whooping cough, and infant diarrhea and enteritis, all especially sensitive to sanitary conditions—illustrate the point. Typhoid fever (caused by the Salmonella typhi bacillus) is contracted through the consumption of contaminated food and water, emerging most floriferously in places where human excreta are not adequately maintained or treated. Between 1903 and 1923, the disparities between white and black typhoid fever mortality were highest before 1915, although they continued thereafter. Whooping cough and diarrhea/enteritis are childhood afflictions. Epi- The Landscape of Health 69 0 10 20 30 40 50 60 70 black typhoid fever mortality white typhoid fever mortality 1 9 2 3 1 9 2 2 1 9 2 1 1 9 2 0 1 9 1 9 1 9 1 8 1 9 1 7 1 9 1 6 1 9 1 5 1 9 1 4 1 9 1 3 1 9 1 2 1 9 1 1 1 9 1 0 1 9 0 9 1 9 0 8 1 9 0 7 1 9 0 6 1 9 0 5 1 9 0 4 1 9 0 3 figure 3-1. Typhoid fever mortality per 100,000 population, Baltimore, by color, 1903–23. Source: Baltimore Department of Public Safety, Sub-Department of Health, Annual Report, 1923, Baltimore City Archives, Baltimore. demics of whooping cough (or pertussis, a childhood disease caused by the bacterium Bordetella pertussis) are often rapid and therefore produce from year to year wildly varying rates of mortality, especially in areas of...