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

4. Establishing Boundaries: Politics, Science, and Stigma in the Early Antituberculosis Movement

From being almost unknown consumption has now come to be a scourge, and we can now cease to call this disease ‘‘the great white plague,’’ for it is as well a plague of the blacks. —Charles S. Bacon, ‘‘The Race Problem,’’ 1903 ∂ e s ta b l i s h i n g b o u n d a r i e s Politics, Science, and Stigma in the Early Antituberculosis Movement 88 Establishing Boundaries T he larger politics of tuberculosis and the race-labor question described in chapter 2 and regional and local political economy presented in chapter 3 provided the ground on which white health professionals and statisticians racialized tuberculosis in the nineteenth century . Though necessary, these two conditions were not sufficient for race politics to play out the way it did within the antituberculosis movement. The racial stigma that mediated blacks’ inclusion in antituberculosis work also derived in part from the expansion of urban public health, itself a social and political response to urban industrial and population expansion. In the late nineteenth century, public health focused strongly on surveillance efforts based in principles of bacteriology and infection that were in many respects controversial and subject to popular and professional resistance and to political compromise. This chapter describes the racialization of ‘‘house infection ’’ theory, which occurred in the very late nineteenth century in response to the class implications of early bacteriology. House infection theory, first introduced in the United States by Lawrence Flick, a physician and tuberculosis researcher at Philadelphia’s Phipps Tuberculosis Institute, referred to the demonstrable proclivity of tuberculosis to be produced in certain ‘‘infected houses.’’ Unlike pathogens that spread by contaminated water or that were easily transmitted over aerial distance, the tubercle bacillus was not distributed uniformly across wide expanses of space. This aspect of tuberculosis, house infection theory implied, required some sort of regulation of the intimate spaces in which tuberculosis thrived. Historians typically have regarded the differences between the theory’s proponents and detractors as the gulf between the pioneers of rational state public health and self-interested private physicians. This assessment is not entirely untrue, although it fails to appreciate the extent to which class-based arguments against house infection theory and against state action relied on a racialization of tuberculosis—specifically, the general speculation regarding the degree to which hereditary predisposition militated against the promise of sanitary reform and surveillance. This would prove important in the compromised manner in which urban health officials approached tuberculosis control among racialized populations, including blacks in the U.S. South, Irish and Eastern Europeans in the North, and Asians in the West. Much of the early debate surrounding house infection theory and its place in regulation occurred at the local level, where black intellectual protest against theories of racial predisposition seldom had entry. Local black agitation instead focused on the absence of care. Mandatory reporting, even in its stigmatization of the poor (especially blacks), vaguely implied the immi- Establishing Boundaries 89 nent arrival of public health attention to black needs, causing black leaders to offer tentative support to the agents of surveillance, the newly formed visiting nurse corps. More importantly, black health activity at the turn of the century embraced a praxis of communal uplift and institution building within which strategic forms of accommodation developed in complete harmony with militant impatience with Jim Crow health care. compromised house infection and the space of race and class Flick’s theory was the epidemiological extension of hypotheses implied by early bacteriology, a ‘‘study in nature’’ of what J. A. Villemin and Robert Koch had shown through experimentation and bacteriological inquiry. Having studied the twenty-five-year mortality history of Philadelphia’s Fifth Ward, whose largely poor residents Flick described as ‘‘about 20 percent. colored,’’ with ‘‘foreigners of every description and nationality,’’ Flick noted the prevalence of tuberculosis mortality in ‘‘infected houses,’’ in which approximately 58 percent of all 1888 Fifth Ward tuberculosis deaths had occurred . This led him to conclude that ‘‘tuberculosis [is] not only contagious in the broad sense of that word, but that a house in which the disease has existed remains a centre of infection for an indefinite time.’’ Flick therefore called for the registration of all consumptives and their dwellings so that local health officials could keep track of the spread of the disease.∞ It was not inevitable that the idea of racial inheritance would play...