Q: Can the history of emotions also offer assistance in understanding America’s persistent fears regarding recent threats of intrusive foreign diseases such as Ebola fever and Zika virus infections?
Risse: Prompted by xenophobia and overt racism, the United States has traditionally sensationalized “invasions” of foreign infectious diseases, blaming arriving weak or unhealthy “others,” for their appearance and transmission. Awareness of dangers, real or imagined, is largely based on assumptions derived from past exposures. Indeed, strong and negative emotions are rooted in experiences reaching back to the earliest conquest and colonization of what was erroneously believed to be a pristine and healthy continent. Unfortunately, the first contacts between indigenous people, conquerors, and settlers lead to the involuntary spread of deadly endemic European diseases conveyed by the new arrivals. These imported scourges—notably smallpox—quickly overwhelmed and decimated America’s adult population exhibiting genetic uniformity and immunological incompetence.
Empires declined or were destroyed, with depopulation forcing the introduction of slaves from Africa afflicted with their own equally fatal cohort of tropical diseases like malaria and yellow fever, all ostensibly sullying the Promised Land. It is therefore not surprising that since colonial times, fear, disgust, and paranoia have shaped responses to imported contagions. “Good health” enhanced the quality of life and became an integral part of the new nation’s identity; it was essential that all risks and threats with the potential of impairing wellness needed to be forcefully thwarted. Similar prejudices about foreign health threats have persisted over the centuries. The 1918 flu pandemic was blamed on a surge of European migrants. Tuberculosis was associated with arriving Jews while Italians and Polish arrivals were held responsible for spreading poliomyelitis. For a while, Haiti was incriminated in the origin of HIV/AIDS. SARS came from China. Not to be excluded were Mexican newcomers, repeatedly denounced for bringing tropical scourges into the United States.
Q: Stigma and scapegoating play powerful roles in your narrative. What made them so critical in San Francisco?
Risse: Stigma in San Francisco resulted from a unique combination of powerful nativist, racial, medical, cultural, and economic ideologies. The term, originally employed in ancient Greece, sought to highlight the presence of certain cutaneous markers or blemishes suggestive of hidden internal defects based on a popular premise that the skin could “speak” and thus mirror troubles of the body and soul. Such a concept easily led to racial profiling and social distancing, misogyny and cultural conflict. Indeed, “stigmata” revealed much about a person’s identity, moral and social standing, as well as health status. The latter could be quickly recognized and diagnosed for a group of infectious diseases with obvious facial lesions that posed a serious danger of widespread contagion.
Given the presence of a substantial number of migrants from China, San Franciscans eagerly discredited Chinatown residents, considering them as potential purveyors of deadly contagious disease such as smallpox, leprosy, syphilis, and plague. Blaming this ethnic population for each epidemic outbreak and threatening to close the district by forcefully returning the inhabitants to their homeland became routine. The vehemence of this critique and blame was exacerbated because of San Francisco’s 19th century reputation as one of the most healthful U.S. cities, a welcome and profitable destination for convalescents, notably those suffering from tuberculosis. With mild weather and tonic breezes, the “city of refuge” worried about the impact of Chinese casualties on their low mortality rates.
Q: Finally, the rather sad story of the shunned and poorly funded San Francisco Pesthouse has a much happier ending. What convinced San Franciscans—a breed known as rugged individualists, to say the least—-to change their approach in fighting contagious diseases?
Risse: The devastating 1906 earthquake and fire with its vast panorama of urban ruin prompted a dramatic shift in outlook. With large populations of homeless and unemployed, the citizens of San Francisco rallied to display solidarity and empathy, adopting a true communitarian approach to deal with all aspects of the catastrophe. The new emotional tone was aided by the attendant rise of progressivism with its plea for political reform, honest government, and respect for scientific achievements. Moreover, San Francisco’s traditional apathy with regard to public health measures was further shaken following another outbreak of bubonic plague in May 1907 that, unlike its 1900 predecessor, afflicted mostly non-Chinese residents.
At the Pesthouse, expanded operating budgets and a brand new ward for plague cases reversed decades of neglect. Federal demands for an anti-rat campaign—the rat was widely believed to act as host for the plague bacilli—led to the creation of a Citizen’s Health Committee, a broad coalition of civic, commercial, transportation and academic interests in January 1908. In the face of feeble municipal resources, the organization pledged to provide funding for a grassroots drive to educate the public and eliminate rats and their sources of food and shelter. This preventive endeavor succeeded admirably within a few months, leading to the elimination of this scourge, allowing civic leaders to proclaim San Francisco “the healthiest large city in the United States.”