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

2. The Rise of the City and the Decline of the Negro: The Historical Idea of Black Tuberculosis and the Politics of Color and Class

Tuberculosis is distinctly a social problem. The microscope has brought about the recognition of this fact. —Lilian Brandt, ‘‘Social Aspects of Tuberculosis,’’ 1903 The truth is that medicine, professedly founded on observation, is as sensitive to outside influences, political, religious, philosophical, imaginative, as is the barometer to the changes of atmospheric density. —Dr. Charles V. Roman, ‘‘A Preventable Death-Rate,’’ 1914 ≤ t h e r i s e o f t h e c i t y a n d t h e d e c l i n e o f t h e n e g r o The Historical Idea of Black Tuberculosis and the Politics of Color and Class 42 The Historical Idea of Black Tuberculosis D iseases and human endeavors to understand them occur in political and social context. The intellectual history of race and tuberculosis suggests that developments in theory, research, and technology— the discovery of the tubercle bacillus, epidemiological formulations, the development of radiographic and tuberculin screening, the use of autopsy data, and explorations of primary infection—were not separable from changing ideas regarding the roles of heredity and environment in disease or from the massive demographic and economic changes that occurred in U.S. cities between the mid–nineteenth century and the mid–twentieth century. The first question that must begin a historical investigation of the development of the antituberculosis movement (and, more broadly, racialized public health) concerns the political and social terms on which an understanding (framing) of the disease unfolded. racial science and tuberculosis in the nineteenth century One historian interested in this problem has noted that ‘‘the focus of interest in the Negro varied with the medical preoccupations of each era and with the particular institutional settings.’’∞ The settings, however, were not merely institutional but were situated within transatlantic discussions regarding human essence, liberal democratic governance, scientific racism, ethnology, and colonialism. The eighteenth century had ended with the notion of human families whose physical and spiritual characteristics varied but mutably conformed to environment, an idea that owed at least as much to philosophical idealism and Judeo-Christian thought as to hierarchicalism inherited from the idea of the great chain of being. By the end of the nineteenth century, however, racial science had moved to a more intransigent racial essentialism, a shift that, broadly speaking, may be attributed to two long-term trends.≤ One was purely intellectual in that the rise of secular science posed an immediate challenge to the unity of humankind described in biblical scripture. In this regard, the early-nineteenth-century emergence of comparative anatomy was important, marking a shift in emphasis from the external features of organisms to an investigation of their interior organs and dynamic systems.≥ So, too, were polygenist theories and paleontology ’s fossil record, which suggested, among other things, both incremental evolutionary changes measured in geologic (not biblical) time and the possibility of species extinction should these changes not prove adequate.∂ Wars also the accelerated movement of populations across the globe, prin- The Historical Idea of Black Tuberculosis 43 cipally through exploration and expansion or through labor migrations. The dramatic loss of life in the face of economic, climatic, and disease challenges seemed to indicate that environmental adjustment was not as easily accomplished as previously had been thought (and hence that racial characteristics might be relatively immutable). The change in ideas regarding ‘‘acclimatization ’’ had an analogue in the U.S. South, where white commentators (no small number of whom were physicians) argued that blacks were best fit for plantation labor and attributed the intense class conflicts between blacks and whites to racial differences.∑ For admirers of the new science of race, the key to understanding racial susceptibility to disease lay in what came to be known as ‘‘diathetical predispositions ,’’ the rather vaguely described inherited anatomical characteristics that in some environments proved useful but in others made individuals vulnerable to certain diseases.∏ Although twentieth-century physicians would focus on specific organs in their relationship to tuberculosis, their mid-nineteenth-century predecessors tended to view the ‘‘consumptive diathesis ’’ as emerging from the dynamic arrangement of all organs, the combination of which constituted an expression of some unseen essence. In 1834, Samuel George Morton, the empiricist founder of the American school of anthropology, described in great detail the anatomy of tuberculous lesions, based largely on data he had collected during his five years as physician to the Philadelphia Alms-House...