Driven by Fear: Epidemics and Isolation in San Francisco's House of Pestilence (History of Emotions), University of Illinois Press; 1 edition (December 30, 2015)

From the late nineteenth century until the 1920s, authorities required San Francisco's Pesthouse to segregate the diseased from the rest of the city. Although the Pesthouse stood out of sight and largely out of mind, it existed at a vital nexus of civic life where issues of medicine, race, class, environment, morality, and citizenship entwined and played out. Guenter B. Risse places this forgotten institution within an emotional climate dominated by widespread public dread and disgust. In Driven by Fear , he analyzes the unique form of stigma generated by San Franciscans. Emotional states like xenophobia and racism played a part. Yet the phenomenon also included competing medical paradigms and unique economic needs that encouraged authorities to protect the city's reputation as a haven of health restoration. As Risse argues, public health history requires an understanding of irrational as well as rational motives. To that end he delves into the spectrum of emotions that drove extreme measures like segregation and isolation and fed psychological, ideological, and pragmatic urges to scapegoat and stereotype victims--particularly Chinese victims--of smallpox, leprosy, plague, and syphilis. Filling a significant gap in contemporary scholarship, Driven by Fear looks at the past to offer critical lessons for our age of bioterror threats and emerging infectious diseases.


List of Illustrations VII

Foreword by Peter N. Stearns IX

Preface XI

Introduction 1

         Emotions 8

         Evolution of Disgust 12

         Hideous Features, Malodorous Bodies 15


Chapter 1 - Domains of Contagion and Confinement 21

         Miasma and Contagion  21

         Stereotypes and Scapegoats 24

         Segregation and Isolation 29

         Banishment in San Francisco 24


Chapter 2 - Framing “Loathsome” Diseases 40

         Deciphering Skin 40

         The Speckled Monster 42

         Great Pox: Manhood in Peril 47

         New Horrors: The Scaly Disease 51

         Arrival of Black Fever 55


Chapter 3 - Tides of Inertia and Neglect 59

         Municipal Parsimony 59

         New Burdens 64

         Reluctant Partners 68

         Shopping for a New Lazaretto 71

         Postearthquake Revival   74


Chapter 4 - Location: Not in My Backyard 78

         Miasma and Racial Segregation 78

         Hunting for Faraway Sites 85

         Enduring Setting 91


Chapter 5 - Banished: Sojourns of the Damned 97

         Tales of Segregation 97

         Life in a Dungeon 102

         Hawaiian Outcasts 106

         Charitable Acts 111

Chapter 6 - Belle of California’s Molokai 115

         Crossing the Final Gate 115

         Chinatown and Leprosy 119

           Chinese Prostitutes 124

           Redemption 129


Chapter 7 - Wary Minders: Custodians and Caregivers1 34

         A Team of Political Puppets 134

         Evolution of Nursing 141

         Medical Overseers and Visitors 146


Chapter 8 - Hope for Cures: Nature of Science 152

         Science and “Loathsome” Diseases 152

         Inoculation Experiments 156

         Palliation 161

         Search for Cures 166


Chapter 9 - Modern Isolation: Humanizing Castaways 171

         Better Image and More Comforts 171

         New Patients and Shifts in Care 178

         Another Pesthouse? Managing AIDS 184


Epilogue 191

         Simulating Bioterror 191

         SARS 194

         Military Mentality 201

         Foreign Invaders 204

         Rehumanizing Public Health 208

Notes 211

Index 291

Editorial Reviews

A deeply researched, very well-written and timely account by the foremost historian of public health policy in the city by the Golden Gate of how emotions of fear and disgust can war with compassion and rational planning in the shaping of a community’s response to epidemics. Risse has made a major contribution to both San Francisco history and American social history by documenting the tangled racial, ethnic, psychological, ideological, and practical roots of the discourse and practice of activists who worked to protect the city’s residents from contagion by smallpox, syphilis, leprosy, and bubonic plague in the early years of the twentieth century. Driven by Fear is an engaging and highly original addition to Western American history and American urban history and a must read for historians and contemporary public health scholars and practitioners.
— William Issel, author of Church and State in the City: Catholics and Politics in Twentieth Century San Francisco
Using a wonderfully drawn history of San Francisco’s Pest House as his primary exhibit, Risse shows us how fear of contagion, if not diluted with compassion and a respect for human dignity, quickly produces harsh, impersonal, and militaristic measures against ‘the enemy,’ people who disgust us simply because they have, or might have been exposed to, whatever the threatening disease of the day is—smallpox, syphilis, leprosy, plague, or even SARS or Ebola. A must read for anyone interested in protecting the public’s health, social justice, and human rights.
— George J. Annas, author of Worst Case Bioethics: Death, Disaster, and Public Health
In this startlingly vivid and humane study, Guenter Risse, doyen of hospital historians, sets a lost history in the context of issues of disease prevention, municipal politics, and the history of the emotions. Only by understanding the lived experience of disgust and fear in the past, Risse argues, are we likely to do better in the present and future with stigmatized diseases.
— Colin Jones, author of The Smile Revolution in Eighteenth Century Paris
This history of the San Francisco Pesthouse offers a rich narrative of the social and political responses to diseases that have frightened humans in the past and suggests that future threats might provoke similar reactions. The necessary balancing of individual freedoms versus social protection is easily tipped through the lenses of fear and xenophobia leading to prejudice, stereotyping and scapegoating.
— Michael Hutcheon, co-author of Opera: The Art of Dying
A true gem from one of our most distinguished historians of medicine. Risse’s book is ambitious, original, and even brave. Driven by Fear covers an admirably wide variety of subjects and subdisciplines, and in the process truly breaks new ground in the history of public health. Moreover, Risse’s prose consistently helps us feel the past—his is indeed an emotional as well as intellectual achievement.
— Robert D. Johnston, editor of The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century North America
Risse explores the personal, medical and political responses to epidemic disease in San Francisco in the late 19th century via lucid and engaging descriptions of how race, class, and identity shaped attitudes to people diagnosed (often mistakenly) with contagious diseases (leprosy, plague, smallpox and syphilis)…The clear narrative engages readers immediately…Risse has a long-established reputation as an innovative historian of medicine and hospitals in particular and has brought his formidable capabilities to this book as well. Thoroughly grounding the book in rich primary sources, particularly newspapers and medical sources, Risse provides a model of sound historical research and storytelling, both of considerable use to undergraduates. Far more than an isolated historical account, the work continually relates the historical implications to modern medical culture and practice.
— F. Gibbs, Choice 63 (Aug 2016)
Driven by Fear frames the San Francisco pesthouse as one example of a public health tradition in which stigma has been historically constructed and invoked to scapegoat and segregate certain groups with the intent of social purification and public safety. Examining medical authorities’ use of emotion-laden rhetoric, such as “loathsome disease” to describe contagious skin diseases, Risse finds that disgust, terror, anger, hatred, dread, anxiety, and revulsion were insinuated into the physical description of smallpox, syphilis, leprosy, and plague…Through a careful ethnographic and transnational analysis, Risse offers meaningful insight into conflicts between Chinese and American culture that generated anti-Chinese prejudice…By focusing on the emotional context of disease and the consequences of coercive confinement, Driven by Fear is a valuable contribution to histories of infectious disease and public health. Its worth goes further in demonstrating how health is interwoven in the histories of the west, women, labor, race, and ethnicity, and points to fertile avenues for future research. By uncovering the ways in which fear of disease framed anti-Chinese prejudice and inspired the legal evisceration of their civil liberties, Risse makes an important contribution to the growing field of literature on the movement for Chinese Exclusion and its consequences…

Most importantly, Risse makes expert use of the history of the pesthouse to illustrate the dangers of authoritarian public health interventions, particularly in mandating the segregation of potentially contagious patients, and makes a persuasive case for community-based, multi-directional responses that conscientiously reckon with the ways in which racial, ethnic, and class disparities frame our understanding of health and risk.
— Vanessa Burrows, Journal of the History of Medicine (prepublication Aug 2016)
Risse’s scrupulously researched book paints a fine-grained picture of the pesthouses in the city of San Francisco and their history as institutions of control and sources of social conflict. The connections to public health policing today are abundantly clear and emphasized in both the last chapter “Modern Isolation: Humanizing Castaways,” and a thoughtful epilogue.
The book explores the many social forces in modern American culture that make isolation, control, and custody both desired and contentious… In Risse’s telling, the story of the city’s pesthouses offers valuable insights into the American form of public health: our zealotry when it comes to identifying carriers, our costly protective measures when the affluent seems to be in danger (vaccinating college students against flu), our sometimes easy access to laissez-faire circumspection when it’s the poor who are in trouble (Zika in Puerto Rico).

As these complex underpinnings play themselves out in a new city in a country newly investing personal industriousness and productivity with moral probity, the drama around the presence of lepers and sufferers from smallpox and syphilis in San Francisco, compounded by the occurrence of repeated outbreaks of plague, is described by Risse. Here the account features nuanced understandings of the views of native San Franciscans toward the Chinese “menace” and toward the development and welfare of their own fair city. His work is particularly strong in its exploration of the connections between racial and moral prejudices and how those ae manifest in the development of public health practice.
The book is valuable for its detailed history of a troubling chapter in medical and public health history. It should be required reading for today’s public health policy makers.
— Philip Alcabes, Bulletin of the History of Medicine 91 (Summer 2017)

Q&A With University of Illinois Press

Guenter B. Risse is a professor emeritus of the history of medicine at the University of California, San Francisco. He answered some questions about his book Driven by Fear: Epidemics and Isolation in San Francisco’s House of Pestilence . . .

Read the full interview HERE at the University of Illinois Press blog.


Q&A Session from San Francisco Public Library Presentation

From the Q&A Session with the Author at the San Francisco Public Library, June 1st, 2016

Read the transcript of the full session HERE.