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

Article excerpt

Samuel Kelton Roberts, Jr., Infectious Fear: Politics, Disease, and the Health Effects of Segregation. Chapel Hill: University of North Carolina Press, 2009. Pp. 328. Paper $24.95. Cloth $59.95.

Samuel K. Roberts's Infectious Fear investigates the racial politics of tuberculosis, primarily in the Progressive Era, and its legacy on health and urban policy throughout the 20th century. For the first half of the century, tuberculosis was one of the top three causes of black mortality in urban areas (it caused 15 percent of black deaths in 1900). African Americans had higher rates of tuberculosis than whites, and it was generally more deadly, especially for children. Roberts's central argument is that "integral to the project of modern urban public health were theoretical and practical compromises that moved the politics of black health from absolute neglect to qualified inclusion based on specific notions of care, expertise, public utility, citizenship, social control, and responsibility." Tuberculosis is also particularly useful in illustrating the racial construction of disease historically and the medicalization of race. Roberts quotes from W. E. B. Du Bois's pathbreaking work, The Philadelphia Negro (1899) on the so-called racial nature of tuberculosis: "Particularly with regard to consumption, it must be remembered that Negroes are not the first people who have been claimed as its peculiar victims; the Irish were once thought to be doomed by that disease--but that was when Irishmen were unpopular."

In Infectious Fear Roberts focuses on the complex politics and negotiations around tuberculosis control and care--between individuals and institutions, the black and white populations, politicians and health experts. Situating his study in Baltimore, a "border city" and a major center of black life, Roberts makes compelling interventions in the historiographies of public health and the African American urban experience. Drawing on a wide range of material from government and charity investigations of tuberculosis to the health and medical literature and case studies of individual consumptives, Roberts effectively situates the politics of tuberculosis in its appropriate historical and geographic contexts. Individual chapters on the historical epidemiology of tuberculosis, racial science, the urban landscape of health, political and economic geography of the disease, surveillance politics, and the focus on the "incorrigible consumptive" effectively build Roberts's case for the centrality of tuberculosis to understanding the politics of black life in 20th-century Baltimore.

In 1896 the Baltimore City Council passed the nation's first statute mandating tuberculosis reporting. Moreover, Baltimore was also the nation's early leader in residential segregation ordinances. These firsts are not unrelated. As Roberts points out, the last decades of incurable tuberculosis coincided with the first decades of federal housing and urban renewal policy that exacerbated racial segregation. More than just a coincidence, the uses and abuses of the language of science regarding tubercular infection saturated the political discourse around "housing blight" and its containment, resulting in the wholesale destruction of black neighborhoods by mid-century, or what Roberts calls the "triumph of infectious fear."

A historian of medicine at Columbia University Medical School, Roberts builds his arguments through an exhaustive study of the primary and secondary literature and draws on the work of Vanessa Gamble, Keith Wailoo, and other pioneering historians of African American health and social work. …