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6. The Web of Surveillance and the Emerging Politics of Public Health in Baltimore
- The University of North Carolina Press
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A woman of average intelligence, or perhaps more, in one of the cities in [North Carolina] had a cook, a very splendid cook she was, too, but the cook did not seem to be right well. . . . [S]he sent her to a physician and found out that she had tuberculosis; and so she said: ‘‘Well, I have some young children here. I can’t keep you any more. You’ll have to go. I’m very sorry.’’ She did, and she made application for work in another home and the lady said: ‘‘Where have you been working?’’ ‘‘Why, I have been working for Mrs. So and So.’’ ‘‘All right, you come back tomorrow and I’ll let you know.’’ So she called up this lady and the lady said: ‘‘Well, the girl had tuberculosis, that’s the reason—and I couldn’t keep her in my ∏ t h e w e b o f s u rv e i l l a n c e a n d t h e e m e r g i n g p o l i t i c s o f p u b l i c h ea lt h i n b a lt i m o r e family any longer.’’ And when that girl reported next day for her job she was informed she couldn’t get it, and there was nowhere in the world for her to go. That’s the thing over and over again. The white woman was doing the proper thing; she must protect herself and her family, but we as guardians, more or less, for the colored race, have no right to send them out to be treated worse than we treat our lower animals. —Dr. L. B. McBrayer, discussion of Martin F. Sloan, ‘‘The Urgent Need of Hospital Facilities for Tuberculous Negroes,’’ 1917 A blossom in a window, in a city’s alley dark—I see it, and my smoldering faith leaps to a glowing spark. —Sarah Collins Fernandis, ‘‘A Blossom in an Alley,’’ 1923 [44.200.249.42] Project MUSE (2024-03-28 23:09 GMT) The Web of Surveillance 141 I n 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. The Maryland 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 the Tuberculosis Exposition, that many black and white consumptives were falling outside of the mechanisms of reporting simultaneously created the imperative that the net of surveillance be cast more expansively and aggressively . Antituberculosis organizations had already appropriated existing administrative models from social work, forming relatively isolated, usually private or semiprivate organizations. These organizations evolved to meet the challenge, either merging or forming alliances to streamline their efforts. The early twentieth century marked the formation of a corps of visiting nurses and a system of dispensaries that became the threads of the expanding tuberculosis surveillance web, all eventually overseen by the City Health Department (chd). After 1904, the antituberculosis movement met with little political resistance. Bacteriological discoveries in the 1880s and political reforms that peaked in the 1890s gave Baltimoreans reason to have nearly unlimited faith in the promises of the Progressive era. Budgets swelled, as did the ranks of increasingly professionally trained health workers. Aside from their not-insignificant failure forcefully to address economic and color disparities, the organizational efforts of antituberculosis crusaders, locally and nationally, were impressive. Many Americans (particularly those not marginalized) found their consciousness of urban space and infection dramatically altered in a matter of years. Yet in its predictions of control and even eradication, the antituberculosis movement soon encountered the inevitable disappointment following wild optimism. Any results that were not monumentally impressive fell short. To explain the seeming delay of tubercular control, the most frustrated pointed to the incorrigible consumptive, a figure representative of disorder and failed social control. Blacks, already stigmatized as members of a premodern race collapsing under the inert weight of its own slow adjustments and disorganization, were particularly susceptible to such scapegoating, but so were the...