CULTURE AND DISEASE IN NINETEENTH CENTURY SAN FRANCISCO (CALIFORNIA)

By the 1870s a range of infectious diseases dramatically demonstrated changes produced by industrialization and urbanization in San Francisco. San Francisco physicians struggled to control not only diseases themselves, but also the exclusive right to interpret, define and treat them. But disease victims turned to a number of popular medical alternatives. A proliferation of health ideologies and the therapeutic choices accompanied the city's early development.; This historical and medical ethnography of 1870s San Francisco examines the cultural construction of infectious disease. It applies the theoretical perspective of medical anthropology to medical history. It examines competing medical ideologies of this period, and presents people's own disease experiences from letter and diary manuscript sources. It examines specifically the socioeconomic setting of a newly urbanized city and the impact of enormous population growth. Physicians argued that San Francisco would be the healthiest of cities were it not for a poor sewage system and the influx of tubercular patients attracted by the city's climate. Examination of disease statistics reveals that foreign-born immigrants and their children were the usual victims of infectious disease. Both "regular" and alternative medical ideologies were based on an equilibrium model of health which did not recognize disease contagion. Manuscript sources illustrate the actual use of all medical alternatives to treat infectious diseases, and belief in their contagion.; Medical professionals a century ago acquired cultural authority and hegemony over alternative practices. In spite of San Francisco physicians' rejection of incipient germ theory, they identified their interpretations of disease with "science". They capitalized upon a growing social endorsement of scientific approaches. Today new cultural constructions of disease continue to challenge biomedicine's authority. An analogy exists between the environmentally-caused infectious diseases of the 19th-century and chronic diseases of today. In neither case was scientific medicine able to have significant impact on disease incidence in spite of its control over social definition and action. Such examination of the cultural context of historical disease experience makes it possible for us to become more self-conscious about current interpretations of health and disease.