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

Samuel Kelton Roberts Jr. joins a recent string of U.S. historians who have productively used urban case studies to examine twentieth-century race and social welfare policy (Kent Germany, Elna Green, Karen Ferguson, Jennifer Trost) and health disparities more specifically (Emily Abel, Keith Wailoo). Based on exhaustive research in the Baltimore City and Maryland State Archives, Roberts charts the historical epidemiology and racial geography of tuberculosis, among the top three causes of black mortality 1900–50 and a disease that "tells us much about the social context, politics, and culture of Jim Crow" (4). Ample maps, photos, and statistical tables complement the text well.

Roberts focuses intensively on Druid Hill, Baltimore's most densely populated and heavily black neighborhood, particularly its "Lung Block," where beginning in 1901, the City Health Department's (CHD) tuberculosis spot maps showed the highest number of deaths among the squalid alley houses. The maps were displayed prominently at the first tuberculosis exposition at Johns Hopkins in 1904, attended by over 10,000. The exposition spawned numerous imitations in other cities and states, including a popular national traveling exhibit in 1907–08, which together prompted the formation of permanent antituberculosis associations in every state by 1917. The Lung Block was Exhibit A in Baltimore's campaign of "infectious fear," which depicted blacks as sources of contagious disease and targeted them first for surveillance by charities and the CHD and later for coercive institutionalization in Maryland's two all-black state facilities, Henryton Sanitorium and Crownsville Mental Hospital. The "incorrigible black consumptive" and the dangers of unclean, undisciplined habits also figured prominently in modern publicity campaigns from both black and white sources. Roberts contends that "The collection of vital statistics—in U.S. public health executed most vigorously in the study of tuberculosis—historically was no more important than their interpretation within the political projects of establishing categories of worthiness, fitness, and citizenship" (83). Roberts's point is well taken, but infant mortality and later syphilis attracted comparable levels of scrutiny. He posits housing reform as the most effective but elusive method of fighting tuberculosis among blacks, and traces the tragic consequences of the city's failure to include alley houses in its 1908 housing reforms due to the influence of segregationist politicians. Beginning with the destruction of Lower Druid Hill in 1929, "the era of slum clearance, public housing construction, and urban renewal mark the endpoint of the history of early twentieth-century African American tuberculosis more appropriately than the advent of antimicrobial therapies in the 1940s and 1950s" (16). Roberts's most original contribution is his use of the black tuberculosis crisis to elucidate the complex relationships between city officials and black and white citizens in the medical profession, charitable and civic organizations, and the press.

Infectious Fear fails, however, to adequately contextualize Druid Hill and its Lung Block within the larger stories of race and Progressive-Era public health politics in other cities, or even in other parts of Baltimore. City and state health officials used the spot map of Druid Hill in a variety of widely publicized venues, making it a national model for "the format and proliferation of imagery of race and contagion" (123). However, Roberts does not discuss how the racial politics of other cities' Lung Blocks played out beyond Baltimore, where a unique combination of northern industrialism and southern racial mores consigned blacks to overcrowded, preindustrial slums ideal for spreading tuberculosis. Yet why did Baltimore, with higher black income and literacy as well as less oppressive segregation laws than other communities further south, still experience higher black tuberculosis mortality than any other major southern city, including nearby Washington, DC, despite Maryland's high per capita spending on antituberculosis efforts?

The level of detail is rich but sometimes overwhelming, and long statistics-laden sentences undermine readability. There are also some troubling omissions. Roberts's...