Priests, Plagues, and Pariahs: Public Health in the Middle Ages

Rights Revolutions and HealthWeek 13SPHL 401, History of Public HealthDr. Marian Moser Jones

Play the button for introduction

1

Part 1: Before the Revolutions

Listen to the memphis mini gitis blues2

1985 report: Calls attention to: "a continuing disparity in the burden of death and illness experienced by blacks and other minority Americans as compared with our nation's population as whole."

Puts racial health disparities on the policy agenda.

"Health disparities," as an identified field of federally-sponsored public health research, can be dated back only toJanuary 1984. n9 That is [*21] when President Ronald Reagan's Secretary of Human Services, Margaret Heckler, inher annual report card on the health status of Americans, called attention to what she later called "a continuing disparityin the burden of death and illness experienced by blacks and other minority Americans as compared with our nation'spopulation as whole." n103

W.E.B. DuBois

Good Bread Alley, Miami, Colored Town, (Overton) 1920s

But it is important to note that long before Heckler's call to arms, researchers and health officials were documentingand striving to address racial gaps in health access and health outcomes. In his 1906 study, The [*22] Health andPhysique of the Negro American, sociologist W.E.B. Du Bois used federal census reports and vital statistics, as well aslife insurance data, to identify the disparities in health status between black and white Americans, even if he did not usethe word "disparities." n16 Now unlike the white statistician Frederick Hoffman, who argued that these differencesresulted from the inherent genetic inferiority of African Americans (this was a widely-held assumption), Du Boisimplicated environmental causes. n17 By environmental causes, I mean the lack of sanitation in segregatedneighbor-hoods where black Americans were forced to live, along with the lack of educational and economicopportunity faced by African Americans, as the fundamental reasons for this disparity.

One example of such a neirhborhood was overtown in Miami, then, known by the disparaging term colored town. This was one of the only places where african americans were allowed to live as most of the town was reserved for white tourists and black people who were working there had to leave by sundown. Colored town had unpaved streets and outdoor plumbing. Even though the city was only established in 1896, this part of town was crowded in 1920: social workers who surveyed the area in 1920 recorded one hundred families living on a single block. similar to the Lung Block in New York city 15 years earlier. So African Americans migrating to cities in the 1910s-1940s faced similar kinds of crowded unsanitary conditions that Southern and Eastern European immigrants had faced in the 1890s-1910s plus strict regimes of racial segregation in which they were shut out from many city services and had to go to black hospitals, black schools, use black only ambulancesall of which received less money than the white schools, hospitals, ambulance servics.. In Colored town, for example, The Miami city government did not even provide trash or other sanitation services to the area. A continualinflux of workers to build and staff the new hotels, homes, and restaurantsthat were opening for wealthy white tourists, combined with tightening restrictions on where black residentscould live, only exacerbated the situation.

And memphis, which we read about in Wailoos book Dying in the City of the Blues, had similar conditions.

Now Du Bois and others fought against these health disparities by actively advocating for the elimination of the underlying limits on educational andeconomic opportunities that he believed led to these disparities. He was a co founder of the NAACP and as editor of its magazine The Crisis advocated and agitated for civil rights for African Americans. He was the chief proponent of the idea of the New Negro- that black Americans were socially equal to white americans and should strive for the rights which the world accords to men and not as Booker T. Washington urged, work for personal uplift while accommodating segregation. So from the beginning of the 20th century civil rights and health conditions were seen as interconnected: Some activists believed that you could not address black health without addressing the injustice of segregation, and that once people had equal rights the health disparities would lessen or even disappear. So you could see this as an antecedent to the social determinants of health theory.4

Sharecropping and (vs.) health

Sharecroppers near West Memphis, Arkansas, 1936

Photo: Carl Mydans/ Library of Congress

Now it wasnt just urban areas where segregation and racism undergirded health disparities. It was in fact mainly in the rural areas. Most African Americans in the area were tenant farmers in the oppressive sharecropping system, which required them to renttheir land, food, and supplies, often at high rates of interest charged by the planters who owned the land, and then payback this with a portion of their crops. This system caused most sharecroppers, black and white, to slip into a cycle ofindebtedness from which they could not escape except by fleeing the area.And it also meant people did not even have the space to grow their own vegetables because all land had to be devoted to the cash crop- Or the money to buy shoes for their children or screens for their cabins.

5

Scourge(s) of the South

Pellagra

Malaria (1870 map)

Hookworm

Lack of medical care/trained midwifery care

Infant mortality

And people in the South suffered from a variety of diseases. Each could have been called the scourge of the south.. But that title went to Pellagra. a disease which causes skin rashes, diarrhea, dementia, and death, was endemic among the poor black and white Southerners, with rates higher among African Americans due to their greater rates of poverty. And in 1914 public health service scientists proved that it was caused by malnutrition- a niacin deficiency- due to the poor diets of sharecroppers and mill workers.

The other, scourges of the South were malaria Malaria was endemic in the south as you see by this 1870 map and through the midwest even.. the anopheles mosquito bit people and people especially those along river vallesy-- lived with the parasites in their bodies, giving them fever, chills, fatigue, sometimes causing fatal illness. And while by the early 20th century people in the midwest and urban areas like washington dc had enough money to buy screens for their houses so they wouldnt get bitten while sleeping. And this caused a reduction in malaria. This was not true in areas of the south where people still lived in unscreened cabins and flood regions.And then there was hookworm. Where children went barefoot and the hookworm parasite larvae wriggled into their bodies through open cuts. And multiplied and then spread to others through feces. It invades the lungs and small intestines, and causes nausea, fatigue, anemis, abdominal pain and other symptoms.

And on top of this there were fewer well trained doctors in the South than in the north as well as well trained midwives- And there was a very high infant mortality rate.

Malaria map, 1870, US, from http://www.pbs.org/newshour/rundown/george-washingtons-medical-chart/

6

1921: Maternity and Infancy Care Act(Sheppard-Towner Act)Grants to states for child, adult health programs, pensions for widows, deserted mothersDevelopment of full-time Maternaland Child Health units in state health departments.Expansion of data collection for infant, maternal mortality rates

Opposed by AMA, Catholic Church, PHS, repealed 1929

Childrens Bureau Report

And this infant mortality rate really did not come to the forefront until birth registration started occurring in the South. And there were government funds beginning in the 1920s for tracking infant mortality and maternal mortality in the south

you can see here that even in 1921 there were only certain areas where births were registered..all of the white states do not have statewide birth registration. And in 1921 the maternalists succeeded in really expanding the mission of child saving Through the enactment of the maternity and infancy care actWhich gave grants to states for..health programs, widows pensons..And really tried to track infant mortality rates in the south and rural areas. And they discovered how high they were in the south. You see these states that are completely colored in are virginia maryland north carolina and south carolina. And this is not because Alabama Georgia and Florida are sowonderful it is because there is no data on them! But Maryland is worse than Mississippi which might have been because Mississippi had limiteddata collection.But in the South they collect data on infant mortality by race and discover that black infant mortality rates are nearly twice as those of white infants.And at this time the majority of African Americans lived in the South.

Source (this and next slide) The Seven Years of the Maternity and Infancy Act, : Washington, GPO, 1931)http://www.mchlibrary.info/history/chbu/20659.pdf

7

Mississippi Flood, 1927 (American Red Cross Report)

Now in addition to the federal governments funding of expanded registration and statistical tracking of infant and maternal mortality, another major phenomenon put a spotlight on health disparities in the South. This was the 1927 Mississippi flood, which By early April had turned the Delta region of Arkansas,Louisiana, and Mississippi into "a vast sheet of water . . . about 1,050miles long and in some places, over 50 miles in width." according to a National Geographic reporter. The flood drowned hundreds of people while destroying theregion's crops and livestock. 8

Black men shoring up levies, 1927 (National Geographic)

Local white planters, the owners of plantations who rented the land to the sharecroppers, enlisted black men, often by force andsometimes at gunpoint, to work long shifts sand-bagging the levees and building out the levees and, as a result,exposing them to [a] higher risk of drowning when the flood overtopped the levees.And if they didnt drown, of course they were subject to malaria from standing water and cuts and scrapes as you see some men do not have shoes.9

Levy Camp, Greenville, Miss. (American Red Cross Report)

And also, many sharecroppers lived in flimsy cabins along the rich soilof the flood plain, while planters and white merchants who provided services to the plantation economy lived in solid,multiple-story homes on high ground. So during the flood, these more affluent whites could simply decamp to thesecond story or attic of their home until the flood receded from their first floor. Most black sharecroppers had nowhereto go except for the refugee camps established by the American Red Cross.And the camps were racially segregated with Black residents being housed along levees in crowded camps again a malarial area so the white residents of these areas could force them to work- and an area also subject to re-flooding.As one report noted, the levy tops were sites of misery and disease, where "[m]ud, rain, cold, hunger, exposure[and] hopelessness led to fatal results." The health officer in Greenville had given typhoid inoculations "earlier in the week in his office to whites only." according to an article in the Chicago Defender, the nations leading African American newspaper.Typhoid inoculations were [considered] a key protective measure against infections from this deadly water-bornbacillus, this microbe that tends to flourish in standing pools of water that accompany floods and hurricanes. "Members of our race are still suffering from measles, mumps, and typhoid.'They received very little treatment, and those who die are cut open, filled with sand, and then tossed into theMississippi River,' the correspondent wrote." 10

Black Refugee Camp, 1927(American Red Cross Report)

A correspondent from the Chicago Defender who visited the black camps wrote,that "epidemics of measles, whooping cough, mumps, scarlet fever, and chicken pox were raging in these camps." The African American camps were also patrolled by white National Guardsmen who were instructed not to let theresidents leave. The local planters feared with good reason that many of the sharecroppers, provided withfree transportation by government and Red Cross boats, would decide to leave the area for the industrial North whereRace relations and employment conditions were somewhat better.And in fact the flood drew national attention to the awful health and economic conditions faced by African Americans and poor whites in the South.And the Red Cross together with the Rockefeller Foundation and other philanthropies began work to improve public health in the flood-affected regions.

11

1930s-40s: Change Comes to the South1.New Deal $$$$ >>> Jobs, Electricity, Farm Mechanization to the South >>> New South of modernization, economic opportunity.

2. 1937 Flood >>> More $$, Red Cross and New Deal Funds to Mississippi valley, Migration to cities.

3. World War II >>> Pull of Jobs in Northern factories + Push of farm mechanization (no more need for sharecroppers) >>> Great Migration of African Americans and some rural whites to North.

1930s-40s: New Deal Electrification, New South The Tennessee Valley Authority Project brings electricity, jobs building dams, to Tennessee and the South

Photos: Douglas Dam, TVA Power Station - Library of Congress

1937 FloodSuch disasters created opportunity in the minds of some reinforcing the centrality of the city as a regional center and further justifying the influx of Red Cross funds and federal aid. Keith Wailoo, Dying in the City of the Blues, p. 77

Photo: Flooded West Memphis Street, 1937 Library of Congress

1940s1.Farm Mechanization2. Wartime Jobs in factories, plants.Lead sharecroppersto leave farms, migrate to cities.Malaria, Pellagra, Hookworm disappear from U.S.

Photo- Cotton Carnival, Memphis, 1940

Review: The Epidemiologic TransitionChronic Disease/accidentsIs replaced (as the leading cause of mortality) by

Epidemic Disease

Early 20th century (US and Europe).

But ongoing.

17

1940s:Tb rates remain higheramong black and Latinoresidents ofUrban areas thanamong whites.

Left:Apartments, South Side of Chicago, 1941(Library of Congress)Right/Above: TB Harlem 1940, by Alice Neel

Economic conditions are better in cities.More access to hospitals, health care.But segregated in many cities.Housing is crowded, segregated by custom or law.TB, which has dropped tremendously among whites, remains much higher among black and puerto rican migrants to cities.People migrate from an unhealthy rural South where they have been subject to numerous health threats, into crowded housing conditions in the cold north. In the painting on the right, Alice Neel portrays Carlos Negrn the brother of her lover, who had moved to Spanish Harlem from Puerto rico two years before and had contracted tuberculosis in this overcrowded migrant neighborhood. Here he is pictured after undergoing thoracoplasty, a procedure to collapse and rest the tuberculosis-infected lung by removing ribs. In his weakness and woundedness, he draws in the viewers empathy. Neel makes Tb, a disease then disappearing into the background amidst growing focus on chronic disease, once again visible, and draws attention to the fact that it is continuing to afflict young men of color. After the war, Tb rates will plummet drastically, as antibiotics to cure it become available. But the crowded neighborhoods of Southern African American and Puerto Rican migrants will continue to bear a disparate burden of the disease well into the 1960s.

Picture on left: http://cdn.loc.gov/service/pnp/fsa/8a29000/8a29800/8a29892v.jpgPicture on right: http://nmwa.org/works/tb-harlem From the National Museum for Women in the Arts In this painting, Neel portrayed Carlos Negrn, the brother of the artists then-lover, Jos Santiago. Negrn, 24 years old here, had moved to New Yorks Spanish Harlem from his native Puerto Rico just two years earlier. Tuberculosis spreads easily in overcrowded urban neighborhoods, and in 1940 the available treatments were drastic. The bandage on Negrns chest covers the wound from his thoracoplasty, a procedure to collapse and rest the tuberculosis-infected lung by removing ribs.Although it encourages empathy, Neels painting is not sentimental. While retaining Negrns likeness, Neel distorted and elongate his neck and arms. She used heavy, dark lines to emphasize and flatten his silhouette. The lines around his wound draw attention to the sunken misshapenness of his left side. Negrns face expresses dignity in suffering while his pose and the gesture of his right hand recall traditional images of the martyred Christ.- See more at: http://nmwa.org/works/tb-harlem#sthash.UvYkKtMB.dpuf

18