Contagious Divides: Epidemics and Race in San Francisco's Chinatown (review)

258 Review CONTAGIOUS DIVIDES: EPIDEMICS AND RACE IN SAN FRANCISCO'S CHINATOWN by Nayan Shah, pp. 398,18 illustrations. Berkeley: University of California Press, 2001; $50.00 (cloth), $19.95 (paper). Nayan Shah, in Contagious Divides, uses a trichotomy of history, geography, and action to critique 19th- and 20th-century public health debates and practices surrounding San Francisco's Chinatown and its residents. This sophisticated and complex account highlights the structural, institutional, and individual factors that defined health and everyday life from the 1800s to the mid1900s . One of the fundamental arguments made in the book is that control over the image and representation of Chinese people and places is critical to understanding the shifting nature and focus of public health policy and practice. Shah divides the book into nine chapters, each of which focus on specific sets of interactions among illness/health, race, gender, and class that defined in large degree the behaviors of white and Chinese residents and advocates, public health and government agencies, and nongovernmental and nonprofit organizations. Each of the chapters focuses on the ways in which Chinese residents and Chinatown are seen as vectors and incubators for specific diseases or illnesses (such as smallpox, bubonic plague, syphilis, tuberculosis, and Chinese infant and child mortality) and the ways in which regulation, sanitization , and surveillance constitute predominant modes of behavior by government bureaucrats, politicians, and business leaders. For example, in Chapter 2, titled "Regulating Bodies and Space," Shah argues that public health officials and the wider public saw the smallpox epidemic as embodied in Chinese individuals (with public health officials having traced the disease to steamer ships from Asia) and therefore geographically situated in Chinatown. This public health understanding of smallpox as embodied in Chinese people and places motivated policies that mandated the social and spatial containment of Chinese immigrants (i.e., individual isolation and spatial confinement in Chinatown). Using detailed examination of public agency and media descriptions of Chinese residents and residences, the author shows how filth, uncleanliness, and even immorality became strongly associated with Chinese living, both in terms of individual lifestyles (e.g., public accounts focusing on the deviance of Chinese bachelor life, opium dens, and female prostitution) and places (e.g., public health agency evaluations of Chinatown having high-density living and mixing production such as cigar making and laundries with domestic living). Other chapters provide similarly detailed accounts of the construction and reinforcement of the social depiction by white public health officials, Journal of Health Care for the Poor and Underserved · Vol. 13, No. 2 · 2002 ToMmshi 259 politicians, missionaries, and residents of Chinese people and places as vectors of disease and the ways in which Chinese women, Chinese laborers, and nongovernmental and grassroots groups resisted such imagery. Shah explains how these stigmatized and stylized images of Chinese people and places become translated into actions by public health staff, politicians, the courts, missionaries, and residents using varied examples (such as the regulation and attempted abolishment of Chinese laundries in San Francisco, the exclusion of Chinese residents pursued by the upscale communities of St. Francis Wood and Nob Hill, and the examination, regulation, and isolation of Chinese and other Asian immigrants on Angel Island). This book makes several contributions to scholarly understanding of health for marginalized and underserved populations. First, the book's focus on gender highlights the importance of white and Chinese women in the formulation of Chinese social identity and in public health policy design and practice. In particular, the book argues the importance and professionalization of Chinese women as physicians, nurses, and social workers who promoted and provided access to Westernized medicine among Chinese residents and families. Second, the author emphasizes the role of nonstate actors (such as nonprofit, religious, and business groups) in designing, implementing , and resisting public health policies and the widely popular social imagination of Chinese life as filthy, immoral, and exotic. Third, the author makes clear the problematic role of the state in pursuing hygienic public health strategies and in depicting and treating Chinese people and places as vectors of disease. Inter- and intrastate conflicts are often integral core elements in each of the chapters. For example, although local public officials saw bubonic plague as directly...