What's behind the impulse to isolate? An urge to commit murder against offenders isn't hard to understand (evidence that humans have been doing such mayhem for at least ten thousand and perhaps forty thousand years corroborates that sense1). The urge to keep certain members of society alive but at bay is harder [End Page 452] to place. By the time the book of Leviticus was compiled, between the sixth and fourth centuries BCE, the practice of exiling those whose skin showed the scaly patches (tsara'at) indicative of uncleanness was evidently already established. That such practices persist, institutionalized in the form of asylums, almshouses, workhouses, prisons, and—significantly for Guenter Risse—leprosaria and pesthouses, attests to the continuing power of this strange urge to both control and care for.
Risse's scrupulously researched book paints a fine-grained picture of the pest- houses 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. "Suspicion and apprehension linger, notably in an American culture that is proud of its organizational prowess and 'can do' resolve, obsessed with safety, and willing to marshal ample resources for quick solutions," Risse points out (p. 209). His incontestable premise is that the impetus for creating and maintaining pesthouses has always been fear. In recounting the history of San Francisco's pesthouses, the book is especially interested in misgivings about Chinese immigrants—which were frequently extended indiscriminately to those of any East Asian ancestry. But this detailed account also takes up the roles played by business interests, concern for property values, rivalries between local and federal authorities, and the increasing valorization of risk avoidance in American society. 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 seem 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).
San Francisco built its first pesthouse, a temporary structure, in 1850, Risse recounts, but refitted the Clarendon Hotel on Stockton Street to serve as an isolation facility during a smallpox outbreak two years later (p. 79). Over the ensuing half-century, the location, relocation, outfitting, and staffing of isolation facilities, and most prominently the judgments about who should be interned there, came to represent a shifting resultant of an unstable set of vectors. These involved the demand to reduce disease risk through sequestration of the suspect, expanding medical knowledge about communicable illnesses, a desire for community-based care for the sick and vulnerable (sometimes honored more in the breach than the observance), economic booms and hard times, concerns for property values (a nineteenth-century forerunner of today's "Not in My Backyard" syndrome), and above all the suspicion and sometimes dread of foreigners. San Franciscans, Risse explains, could see Chinatown residents as an embodiment of the stereotypical uncivilized immigrant (p. 25). The pesthouse expressed a modern ambivalence, the rubberneckers' dilemma: there is death in life, sentences levied by disease from which there is no return. We must look, even though we can't stomach the sight.
As these complex underpinnings play themselves out in a new city in a country newly investing personal industriousness and productivity with moral probity, the [End Page 453] drama around the presence of lepers and sufferers from plague and syphilis in San Francisco, compounded by the occurrence of repeated outbreaks of plague, is described by Risse. Here, his account features nuanced understandings of the views of native San Franciscans toward the Chinese "menace" and...