SAN FRANCISCO’S PLAGUE: THE VIEW FROM CHINATOWN Previous publications including my own sought to recount and analyze the arrival of bubonic plague in San Francisco during the year 1900. This outbreak --the first in North America--generated radical and conflicting responses from federal, state, and local authorities, merchants and medical elites. According to the existing sources, the epidemic was restricted to Chinatown, leading to dramatic quarantines of the entire district and repeated sanitary campaigns inside its perimeter that culminated in the demolition of houses and threats to permanently expel all residents. Most of the information about the plague and its impact derive from official municipal, state and national documentation, together with accounts published in local newspapers heavily tinged by racism. However, the available historical works share a common shortcoming: they failed to view the events through the eyes of the Chinese. Therefore, it was time to balance these reconstructions by including the contemporary beliefs and practices of the community directly affected by the plague: the people of Chinatown. This project, funded by a grant awarded by the National Library of Medicine in 2007 proposed to remedy the omission. The goal was to systematically examine news and editorials dealing with plague, public health, and medicine printed in the leading San Francisco Chinese language publication of the day, the daily newspaper Chung Sai Yat Po ((Chinese Western Daily). Preliminary investigations suggested that during the plague this widely circulated newspaper became an influential voice in the community, breaking ethnocentric barriers and encouraging the community to organize and fight discrimination. With help from a team of Chinese translators located at the University of California, Berkeley, the proposed study aimed to produce a monograph integrating both the Western and Chinese narratives of the bubonic plague outbreak from 1900 to 1904 within a transnational framework. An exploratory paper titled SAN FRANCISCO’S CHINATOWN AS ‘PLAGUE SPOT’: ARCHITECTURE, ENVIRONMENT AND SOCIAL RELATIONS was delivered at an international conference sponsored by European Association for the History of Medicine and Health, London, 14 September 2007. Under the auspices of the National Library of Medicine Seminar Series, the Office of NIH History and the Washington Society of the History of Medicine, the illustrated lecture BRIDGING THE EAST-WEST DIVIDE: GENESIS OF A CHINESE HOSPITAL IN SAN FRANCISCO,  was presented 16 April 2008 in Bethesda, and again under the auspices of the Chinese Hospital and Chinese-American Citizens Alliance, San Francisco, 26 October 2009. A seminar TRANSCULTURAL HEALTH POLITICS: PLAGUE IN SAN FRANCISCO’S CHINATOWN, 1900 took place at the Rollins School of Public Health, Emory University, 17 April 2008.  After several years of research and writing, a new book, titled PLAGUE, FEAR AND POLITICS IN SAN FRANCISCO’S CHINATOWN will be published in the spring of 2011 by Johns Hopkins University Press. Its conclusions offer valuable lessons for understanding the consequences of racism and contemporary management of public health campaigns for global epidemic outbreaks such as AIDS, SARS and avian influenza. Further related research on the ecology of disease in California as well as the tragic story of the San Francisco “pesthouse” is in progress.

PATIENTHOOD IN HISTORY AND SOCIETY   History has an important role to play in future debates concerning therapeutic relationships. Roles played by patients and physicians reflect the dynamic character of all human relationships. Simple “topdown“ models of interaction should be replaced with more nuanced accounts that focus on the complexity and diversity of motives, interests and understandings. Today, we are struggling with conflicting models on how to negotiate authority in medicine. The patient’s plight has only recently become an important topic for historical research. Traditional accounts have disproportionally focused on the lives, ideas and achievements of “great doctors”. In his 1985 essay “The Patient’s View: Doing Medicine from Below’, Roy Porter suggested the development of an alternative history of medicine written from the patient’s point of view. Highlighting some of the shifting definitions and meanings of patienthood offer valuable insights into current health care dilemmas. My own professional journey has closely paralleled Porter’s approach. Most of my published work in the past three decades, including two books on hospital practice and therapeutics, and several published essays that can be considered patient-centered. A few years ago, I also had the opportunity to be a year-long member of an interdisciplinary working group sponsored by the Hastings Center in Garrison, New York. The so-called “Rippel“ Project dealt with the role of the clinician-patient relationship in cancer care and research, and my role was to prepare a paper explaining the contexts and microethics of the new American patient-physician relationship, especiallly in relation to the care of cancer patients. Stimulated by past and present patient narratives,  I prepared a broad overview concerning the evolution of patienthood “from sinfulness to autonomy“ covering a period from preliterate societies to the present. This unpublished essay will serve as a blueprint for searching for additional historical voices and explore issues of class, gender and ethnicity shaping therapeutic relationships within various cultural contexts. Further work on this topic is planned, including an examination of patients afflicted with the often bizzare Munchausen syndrome.

ECOLOGICAL AND HISTORICAL PERSPECTIVES ON HEALTH, DISEASE AND HEALING   The history ofhealth and disease has a rich historical tradition extending back to antiquity. Long an interest of medical historians, the history of diseases has recently been placed into much more complex biological and social contexts. New scientific discoveries have exposed the unprecedented scope and complexity of the interactions between humans and the environment. . Should historians attempting to reconstruct human biology in past populations by enlisting current biomedical information to possibly confirm the presence of particular infectious and chronic diseases in past populations? I believe it is time to employ new tools and evidence for a revision and expansion of our historical reconstructions. Current insights into the molecular structure of microorganisms and their interactions with human immunity have only reaffirmed the dynamic relationship between them—see the current dilemmas concerning the global threat of bird flu. I fully realize that our current scientific criteria are also socially framed and subjected to future changes. Competing etiological hypotheses—in the case of Black Death historians discuss bubonic plague and anthrax as the most likely diagnoses—are common. Indeed, contemporary insights and conclusions are themselves subjected to an accelerated rate of change, but so is everything else being studied and analyzed. There can be no “definitive” history of health, disease and healing, but correlating, for example, DNA mapping from paleopathological specimens with textual evidence, we will learn a great deal more about the health conditions of our ancestors. Techniques such as computerized tomography and magnetic resonance imaging as well as sophisticated biochemical analyses can be extremely informative for both historians and medical researchers—witness the extraordinary window into Neolithic life provided by the recent discovery of the Tyrolean “iceman.” The next step in the process will be to integrate the new scientifically informed history of health and disease with documented past medical efforts aimed at coping with the problem of sickness. Did specific past ecological conditions influence societal belief systems regarding notions of health and disease? If so, what kind of institutions and strategies were developed within specific political, economic and cultural contexts to deal with them? How did these systems affect cognitive and communicative processes and shaped their resulting therapeutic efforts? Where there paradigms in medicine, and if so, why did they change? What was the societal context in which such theories flourished and perished? Such a synthesis will undoubtedly be difficult to achieve. Perhaps the employment of a selected number of case studies from the past—a strategy successfully employed in my book Mending Bodies-Saving Souls: A History of Hospitals (1999)  could provide a blueprint. As one scholar recently observed, “truth depends on contexts and history is a truth-optimizing pursuit,” slowly improving as we gradually uncover more information about the complex web of causality between health, disease and healing. Can medical historians enter the arena of relevance? Can the past help inform the present and point out some of the dangers that could unravel our civilization? A few years ago, Pulitzer Prize winner Jared Diamond in his national bestseller Guns, Germs and Steel lamented the fact that “most historians do not think of themselves as scientists and receive little training in acknowledged sciences and their methodologies.” Given my own background I will attempt to bridge presumed specialized fields of knowledge. In the twilight of my career, I feel a responsibility to integrate knowledge from many disciplines and forge some kind of synthesis. HISTORY IN THE POST-GENOMICS ERA: NEW PERSPECTIVES ON HEALTH, DISEASE, AND MEDICINE