Read an Excerpt
Driven by Fear
Epidemics and Isolation in San Francisco's House of Pestilence
By Guenter B. Risse UNIVERSITY OF ILLINOIS PRESS
Copyright © 2016 Guenter B. Risse
All rights reserved.
ISBN: 978-0-252-08138-5
CHAPTER 1
Domains of Contagion and Confinement
We have seen how the idea of contagion is at work in religion and society. We have seen that powers are attributed to any structure of ideas, and that rules of avoidance make visible public recognition of its boundaries. ... Each culture must have its own notions of dirt and defilement.
— Mary Douglas, Purity and Danger (1966)
Miasma and Contagion
"All epidemics," a recent New York Times article proclaimed, "are emotionally alike: an onslaught of fear, awe, repulsion, stigma, denial, rage, and blame." Indeed, such a behavioral cycle guides the search for meaning. The pursuit spawns a number of explanations that attempt to identify and denounce specific culprits: weather, religion, government, and, most commonly, foreign people and their belongings. Sin, for example, has often been invoked as a cause for disease episodes, leading to horrific abuses during the Black Death. Blaming the victim continues to be a common survival skill, employed for defense and self-preservation.
Isolation, for its part, historically involved the banishment and care of already infected persons, promptly exiled to secluded and secure facilities colloquially termed "pesthouses." Justification for such defensive actions rested on the assumption that the bodies of the sick and their possessions exuded vitiated mist in need of containment and eventual dispersion into distant, open air. The classic theory of miasma (a Greek word meaning "pollution" or "polluting agent") held that many diseases arose from foul, poisonous, and localized vapors steaming from the decay and putrefaction of animal and human corpses, excreta, spoiled foodstuffs, and stagnant marshes. Further elaborations of this theory posited the existence of aerial particles, "fomites," or seedlings of disease that could float around, penetrate, and impregnate the body. Although the nature and qualities of these stains or taints remained obscure and their materiality debatable, the overt effects were believed to be harmful and often deadly.
While adverse local environmental conditions or "atmospheric impurities" were habitually blamed for mass-disease outbreaks, the portability of such diseases and their potential for spreading to other regions and new people through person-to person contacts raised early concerns. Trade and commerce, wars, and world exploration all created opportunities for intercourse between people and cargos from different areas of the globe, intercourse that had profound implications for their health. Today we recognize that humans adapt to a complement of potentially harmful microorganisms closely associated with their towns, regions, and countries. However, when such distinct agents, parasites, bacteria, and viruses spread to new territories and vulnerable populations, they often trigger widespread and severe epidemics. Throughout history, voyagers, traders, and migrants unwittingly breached local ecological niches featuring particular microorganisms and human immunities. The consequences were often devastating, especially for populations without previous exposure to such pathogens.
Coping with contagious disease thus became essential for the survival of societies around the globe. Detection and avoidance were emphasized and isolation gradually gained favor, especially in more densely populated commercial centers and port cities. To this day, draconian measures remain at the center of politically shaped health strategies designed to establish firm boundaries for the protection of a population, overriding personal and property rights in the process. During the Black Death, the wealthy either fled or were shut in their homes or special places by police orders. Such steps, while justified as a public imperative, could be cruel and deleterious, particularly if the occupants were left without provisions and assistance. Aggressive segregation, however, was often counterproductive, fostering distrust, fear, and panic and thus encouraging flight, concealment, and social chaos. Paradoxically, the policy of containment could become a deadly choice: it often left locked-up inmates of pesthouses in crowded conditions exposed to an increased risk of cross-contamination and death. Totally isolating and imprisoning sick individuals in distant establishments shunned by everybody, including frightened and reluctant caregivers, could be humiliating, even devastating. Risks were multiplied by the fact that most epidemics were not well understood by the medical profession. Often diagnostic errors and institutional abuse proved fatal. Panic turned into boredom and despair; rage followed hopelessness.
Under such circumstances, the notion of contagiousness became central to the task of targeting unwelcome agents of disease. However, like miasma, the concept of contagion, while similarly displaying a venerable pedigree, took on several imprecise meanings. Originally, the word "contagion" referred to a sense of communication by touch — contingere — that gradually acquired connotations of harmfulness and corruption. By the twelfth century contagion was simply viewed as internal bodily pollution; it eventually became synonymous with disease caused by an invisible agent, whether a demon or an airborne threat. Other vague traditional ideas like infection similarly were associated with taint and contamination.
As late as 1885, one of the most distinguished San Francisco clinicians, William Kerr, was debating the definitions of "contagion" and "infection," joining a medical dispute that had been ongoing for at least a century. Kerr explained to his readers that contagion required actual physical contact with the person suffering from disease, whereas infection suggested contamination from air, food, clothing, or other substances and objects through inhalation, bodily inoculation, or ingestion. Diseases could be caused by special environmental poisons entering the human body; these could be considered contagious if the agent was communicated directly by touch and multiplied within the body. They were "miasmatic-contagious" if the poison reproduced after the person was exposed to unfavorable external sources. Kerr's efforts to interpret disease transmission employing what the newly minted bacteriologists derisively called "pre-Pasteurian mythologies" exemplified the ambiguities and confusion still prevailing at the dawn of a new era.
Like all transitions, the journey from the miasmatic paradigm to the germ theory of disease was gradual, involving a whole generation of physicians who tried to reframe their clinical and epidemiological experiences based on new information derived from the laboratory. For a quite a long time, medical authors employed various meanings of the word "contagion" interchangeably to explain not only a threatening transmission but also the very agency of disease, strongly associated with geography, environment, and religion. "Contagion anxieties," in turn, became a convenient metaphor for highlighting perceived moral as well as political and cultural hazards. To this day, contagion — used to designate a communicable disease with pandemic implications or as a metaphor for proliferation and diffusion — continues to haunt an increasingly connected planet with an exploding population, mounting trade and migration, and ever more wars.
Stereotypes and Scapegoats
Sunny California's presumed healthfulness required eternal vigilance. Although desirous of immigration, "she wants the healthy and not the diseased," declared one San Francisco health official, William F. McNutt Sr., in 1889. In his opinion, the influx of consumptives and other sickly arrivals would transform the region into a "vast hospital and burial ground for the nation." The state needed to "develop a race strong in body and mind" by avoiding the contamination of its young blood "with the worst enemy mankind has met." California was to be "a breeder of strong men, not bacilli." Unlike other large nineteenth-century American communities, San Francisco was confronted during and after the gold rush with a large number of people arriving from Asia. They created a cultural milieu where the rewards of individual effort and material success were widely celebrated but reluctantly shared with the less worthy poor. Rapid urbanization, economic change, and the dislocations created by immigration gave rise to profound social anxieties and vulnerabilities. Cultural barriers hampered emotional bonding. A largely unbridled bachelor society lodged in hotels and boarding houses. Bold, aggressive, and entrepreneurial, they had little use for compassion and mercy. Fears were repeatedly expressed that newcomers secretly harbored diseases endemic in their countries of origin that would spoil the pristine Shangri-La that was San Francisco. Given the initial lack of knowledge about the causes of disease and the urgent need to explain the menace, scapegoating was a common human coping mechanism designed to shift blame — like the biblical goats banished into the wilderness — for undesired events onto select "others," sectors of society already marginalized on account of their social status, race, religion, or nationality. This mechanism still plays a fundamental role in assigning agency for the appearance of harmful diseases.
In San Francisco, scapegoating was based on the belief that foreigners — notably the Chinese — threatened the health and life of American residents. In fact, unusual physical appearances in general suggested a combined lack of physical stamina, racial degeneration, filthy surroundings, and moral failing. Although diseases among Chinese immigrants were more often the result of systematic discrimination and economic inequality, medical doctrine insisted that their bodies were constitutionally weak, the consequence of degenerative hereditary processes and an unhealthy lifestyle. The question of racial inferiority had already been raised during earlier epidemics in India and China, where morbidity and mortality overwhelmingly afflicted the natives instead of individuals of "European blood and stamina." Such lack of vigor was blamed, in part, on a preference for eating rice. As late as September 1907, as plague reappeared in several sections of San Francisco, Rupert Blue, the leading federal official in charge of the sanitary campaign to suppress it, suggested that "particular care must be taken of the Asiatic section because of the low vitality of many residents there who fall an easy prey to infection which hardier bodies will throw off easily."
In the wake of the gold rush, "xenophobic propaganda" turned China into America's favorite scapegoat. From the start, the massive influx of Chinese immigrants elicited strong aversive emotions. "China is diligently taking emetics to empty her disagreeable stomach in our basin before the cover is clapped upon it by law," observed a local periodical. Indeed, residents in San Francisco's Chinatown came to fully embody the stereotypical, uncivilized "smelly immigrant" prominently represented among the population exiled to the local pesthouse. They were deemed inferior, disgusting, and dangerous because of all their "native habits and inclinations, diseases, and hideous vices." The dislike started with the Chinese facial appearance. Westerners described a childlike semblance as flat and dull and disdained the "shifty" fish eyes, small chin, and pale yellowish skin color suggesting infirmity. The paucity of expression that arose from a Chinese proscription against open displays of emotions except on specific occasions and in larger contexts was read as insensitivity, contempt, and even arrogance. An overwhelming number of these Chinese immigrants were poor and uneducated, and their habits and behaviors — reflective of a collectivist rural past — clashed with an established Western urban ethos based on individuality and personal expression.
Crammed within a few city blocks because of blatant racism, an expanding Chinese population was forced to adjust and survive in a high-density urban ghetto. Water supplies were quite expensive and sewers inadequate. Thus, sanitary facilities were scarce, prompting residents to relieve themselves on the streets. Most tenements were owned and controlled by white landlords charging outrageous rents that encouraged multiple subleases and partitions of houses into units that lacked plumbing facilities. Forced to be relatively self-sufficient, the district featured its own butchers and produce stores in a city lacking a municipal garbage collection system. Outdoor food preparation added another panoply of unusual scents and refuse that baffled but ultimately insulted most Western eyes and noses. The Chinese employed a great variety of ingredients that reflected a cosmic correlation of flavors, odors, and colors. Cooking relied on a generous employment of oil and thousands of portable stoves, generating clouds of smoke mingled with whiffs of opium and tobacco products that engulfed the entire district. According to contemporary author Bret Harte, there was a pervasive "Chinese smell" shaped by location, weather, and communal practices, a "singular medicated odor — half opium, half ginger." For residents, these scents had been part of their farming world for millennia and were never considered health hazards.
Beyond a polluted environment, standards of contemporary European urban politeness and etiquette espoused by nineteenth-century middle class dwellers were found wanting in Chinatown. Locals and visitors alike spun endless tales concerning the disgraceful manners and rude behavior of Chinese immigrants and condemned their noisy and repulsive eating habits. Much was made of their smacking, chomping, slurping, and belching, an ethnic etiquette dehumanized by Westerners, who equated the practices with livestock feeding at the trough. Use of hands and chopsticks instead of cutlery was similarly frowned upon. More importantly, there were frequent complaints about snorting, sniffing, and especially spitting, considered part of traditional Chinese culture and identity. Spewing secretions on streets and walls in densely populated areas was considered particularly dangerous, and fines for violators of an antispitting ordinance were repeatedly proposed but rarely enforced. Such an open discharge of bodily fluids clashed with Western decorum. In time, the Western sanitary gospel became an ever-more potent and stigmatizing weapon in mobilizing the local citizenry against an expanding and dogged Chinese resident population through linkages between race, dirt, and disease. During the 1869 epidemic, San Francisco health officer C. M. Bates explained in his annual report that Chinese immigrants lived in "filthy and dilapidated tenement houses like so many cattle or hogs."
In San Francisco and elsewhere, the burden of cleanliness usually fell on wives and mothers, who played critical roles in housecleaning, food preparation, and child care. In Chinatown, women were largely absent owing to immigration restrictions, and so overall sanitation as well as personal and family hygiene came to be seriously jeopardized, a reality seldom considered except in discussions about Chinese violence and prostitution. Most migrant bachelors, busy and focused on their low-paying jobs, balked at the need for sanitary improvements, clearly not persuaded of the health benefits promised by the new Western hygiene. Their reputedly shameful lifestyle and neglect clashed with the new standards. For the Chinese, there was no incentive for changing local sights and smells: they were deemed natural and culturally entrenched, and they were accepted as part of their identity. An abundance of vituperation instead of action only proved counterproductive. Paradoxically, disgust could even foster an aura of forbidden fascination. The very image of a polluted and degraded Chinatown turned the district into one of the greatest San Francisco tourist attractions. Entering an alien physical and cultural reality seemed intriguing, even exciting. To confirm stereotypes and perceptions of inferiority, guides would escort their aroused customers through the worst-kept alleys, opium dens, and basements, preferably at night to heighten intrigue, revulsion, and a feeling of danger among visitors.
(Continues...)
Excerpted from Driven by Fear by Guenter B. Risse. Copyright © 2016 Guenter B. Risse. Excerpted by permission of UNIVERSITY OF ILLINOIS PRESS.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
