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Doody's Review ServiceReviewer: 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."