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

5. Locating African Americans and Finding the ‘‘Lung Block’’

Recently a lady telephoned me about her servant. . . . Her fears had been aroused by the fact that the girl had been coughing for a long time—several months, and having seen the T.B. exhibit in Richmond, she feared consumption. And so it proved. —Dr. Truman A. Parker, ‘‘The Negro as a Factor in the Spread of Tuberculosis,’’ 1909 Our failure to be represented is not of our own working. —Ferdinand L. Barnett, The Reason Why the Colored American Is Not in the World’s Columbian Exposition, 1893 ∑ l o cat i n g a f r i ca n a m e r i ca n s a n d f i n d i n g t h e ‘ ‘ lu n g b l o c k ’ ’ 108 Finding the ‘‘Lung Block’’ A fter 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 surveillance differed in that it stood to affect a larger proportion of the populace and a greater range of classes, all of whom had to be asked to support a policy that required them to surrender a certain aspect of their privacy. Binding the two problems were the geographic aspects of the disease. The professional acceptance of house infection theory was hastened by the publication of studies in the United States, Britain, and Europe, with the result that, as Anne Hardy has argued, the theory produced a neomiasmatic way of thinking about ‘‘epidemic streets’’ and their relation to the changing industrial geography of the city.∞ The problem of tuberculosis surveillance was modern in the sense that house infection and more generally the ascendance of bacteriology had motivated it, but its modernity cannot be separated from the context of the multiple problems of the color line in new urban geographies or from Progressive era philosophies and practices of civic awareness.≤ What developed in this context was a massive campaign in which, for the purposes of expediting public assent to mandatory reporting, health officials and social investigators framed the geography of tuberculosis expansively to include the racial composition of an area’s inhabitants. Bound up with all the stigma and social meaning that such a geography implied, racialized space was to be regarded as a simultaneous expression and a cause of illness. The result was a view of the disease that obfuscated its underlying causes. This view directly informed Baltimore ’s flawed 1908 policy of housing reform. In the same way that the popular and compromised uses of house infection theory provided a shorthand for racial stigma, so, too, did subsequent social investigations. As a prominent feature of this development, the mapping of tuberculosis mortality necessarily privileged space over time in that it rendered illness static, something to be represented as a geometric point or dot on a grid. By representing the end result of illness (death), the spot map was entirely ineffective for conveying the social processes that created the geographic distribution of health disparities. No apparent causal relation Finding the ‘‘Lung Block’’ 109 (through, for example, the process of urban underdevelopment) would have been apparent between the inequality that produced the ill terrain of poverty and the fear felt by residents of Baltimore’s more affluent neighborhoods. Disease was to be represented as a matter of space that was at once disconnected (discrete ethnic enclaves or ghettoes in which pathologies thrived) and connected (through commercial interdependence). This chapter outlines the politics of the ‘‘discovery’’ of Baltimore’s ‘‘lung block,’’ the geographic sign for black tuberculosis and cross-color contagion, leading, as described in chapter 6, to the implementation of surveillance and care. The dynamic I describe therefore had a dramaturgical element.≥ There was the discovery of the problem: house infection. Sensational investigation and public revelation followed: the social survey, begun in England and soon imported to the United States, had enjoyed a half-century genealogy by 1900, when it was speci...