Infectious Fear: Politics, Disease, and the Health Effects of Segregation / Edition 1

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For most of the first half of the twentieth century, tuberculosis ranked among the top three causes of mortality among urban African Americans. Often afflicting an entire family or large segments of a neighborhood, the plague of TB was as mysterious as it was fatal. Samuel Kelton Roberts Jr. examines how individuals and institutions—black and white, public and private—responded to the challenges of tuberculosis in a segregated society.

Reactionary white politicians and health officials promoted "racial hygiene" and sought to control TB through Jim Crow quarantines, Roberts explains. African Americans, in turn, protested the segregated, overcrowded housing that was the true root of the tuberculosis problem. Moderate white and black political leadership reconfigured definitions of health and citizenship, extending some rights while constraining others. Meanwhile, those who suffered with the disease—as its victims or as family and neighbors—made the daily adjustments required by the devastating effects of the "white plague."

Exploring the politics of race, reform, and public health, Infectious Fear uses the tuberculosis crisis to illuminate the limits of racialized medicine and the roots of modern health disparities. Ultimately, it reveals a disturbing picture of the United States' health history while offering a vision of a more democratic future.

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Editorial Reviews

Doody's Review Service
Reviewer: Kurt M. Boughan, PhD (The Citadel)
Description: This is a social history of pulmonary tuberculosis from the perspective of the African American experience in the post-Reconstruction urban U.S. South.
Purpose: The author, who holds a dual appointment at Columbia University as an associate professor of history and an assistant professor of socio-medical sciences, analyzes the complex relationships among race politics, the development of modern public health measures, and medicine in the struggle against TB in Baltimore from approximately the discovery of the tubercle bacillus in the 1880s to the advent of effective chemical therapies in the mid-twentieth century. He presents Baltimore as a case study in how institutional racism, especially spatial segregation, determined - indeed, was central to — U.S. anti-tuberculosis policies in the last decades before effective pharmacological treatment. The unfortunate result was that, while overall infection markedly declined, blacks continued to suffer and die from TB in proportionately far greater numbers than whites.
Audience: This is a sophisticated work of medico-social history intended primarily for academic historians. It assumes that the reader is deeply familiar with U.S. social history, and especially with African American history. The author's credentials as a social historian of U.S. medicine and race are impeccable.
Features: The author approaches the connection of African American and tuberculosis history in Baltimore from several angles. The first chapter lays out and explains the epidemiological statistics of morbidity and mortality from TB by race in the period under consideration, along with the science of the disease as understood today. This is preparation for the more interpretative, original, and compelling content. What follows are a review of the racialized scientific understanding of TB in the period; a study of the "landscape of health" in Baltimore, with special attention to its overcrowded, unsanitary black slums; a piercing analysis of the scientific mapping of TB morbidity and mortality rates in the city in the first decade of the twentieth century, and the role of TB "spot maps" in furthering the public perception of the disease as a black stigma. Roberts shows that the story of African Americans and tuberculosis cannot be told in terms of simple neglect on one hand and enlightened progressivism on the other. Baltimore authorities, black and white, addressed the problem of rampant TB in the city's black ghettos in ways that were complex and often inconsistent.
Assessment: This is a major contribution to the historical study of disease in United States. It is meticulously researched, critically acute, and displays an impressive grasp of the clinical aspects of TB, both present and historical. Its main shortcoming is the author's verbose and awkward writing style. Sprawling, overwrought sentences - a common vice of the social historian - often obscure the author's cogent and compelling analysis. Lay readers, including interested healthcare professionals, might be put off as well by the frequent (but also necessary and judicious) use of social history jargon. They might find befuddling the numerous references to advanced concepts in social and literary theory. Readers should persevere through the book nonetheless. This work is a welcome corrective to simplistic, celebratory, hero-making narratives of medicine in the decades around 1900. It is a useful reminder of what leading African American physician Charles V. Roman already observed in 1914 in connection with the black TB death rate. As the author duly reports, Roman wrote: "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."
From the Publisher
A meticulously researched, densely written survey of the bleak landscape inhabited by black Americans with tuberculosis (TB) during the Jim Crow era. . . . An insightful and sorrowful view of an important subject.—The Journal of American History

A major contribution to the historical study of disease in the United States. . . . Meticulously researched, critically acute, and displays an impressive grasp of the clinical aspect of TB, both present and historical.—Doody's Review Service

A solid contribution to research on health disparities, a field that needs to do much more to acknowledge that such disparities have deep historical roots that require excavation.—American Historical Review

Will appeal . . . to highly specialized researchers interested in public health politics.—Choice

An impressive work that presents a rich picture of the interaction of some of the factors shaping Baltimore in the early twentieth century.—Louisiana History

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Product Details

  • ISBN-13: 9780807859346
  • Publisher: The University of North Carolina Press
  • Publication date: 5/1/2009
  • Series: Studies in Social Medicine Series
  • Edition description: 1
  • Edition number: 1
  • Pages: 328
  • Sales rank: 704,770
  • Product dimensions: 6.10 (w) x 9.20 (h) x 0.90 (d)

Meet the Author

Samuel Kelton Roberts Jr. is associate professor of history at Columbia University and assistant professor of sociomedical sciences at Columbia's Mailman School of Public Health.

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