[Elizabeth Fee:] Rob Mortensen, representing that office, we'll introduce our speaker in

a moment and also the Washington Society for the History of Medicine.

So we're collaborating to hopefully put on some very interesting programs for you.

And to welcome you, David Cantor is the president of the Washington Society for

the History of Medicine.

[ Footsteps ]

[David Cantor:] We will get to the talk eventually.

We have multiple introductions, but I would just like to welcome you all

on behalf of the Washington Society of the History of Medicine to this talk.

I'm very pleased to have Professor Risse here to speak for us, but to speak to us today or

maybe even for us today. I would also like to note some upcoming

events on behalf of the Washington Society-- well, actually another jointly

sponsored event by the Washington Society, the History of Medicine Division

of the National Library of Medicine and the Office of NIH History.

And this is the Graduate Student Symposium, which is happening on the 2nd of May [2008]

this year here in the Lister Hill building and actually in the Visitors Center.

If you have any graduate students or you are a graduate student in the history

of medicine or the biomedical sciences, this is the event to come to apart from that is,

from Professor Risse's talk. And you can obtain copies of this

and also membership of of the Washington Society from Judy Chelnick,

who is in the white here at the front. So once again, welcome Professor Risse,

and I'll hand you over to Rob Mortensen.

[ Footsteps ]

[Robert Mortensen:] I wanted to introduce Guenter Risse to you, not in my capacity working here at the NIH,

but as a former student of his. He was chair of the department when I was

at UCSF and entered in the early 90s or late 80s to pursue a doctorate in history

of medicine and the characteristics of--- he's an extraordinary teacher, and one of

the characteristics of Guenter compared to many other history of medicine programs,

where history of science programs is his insistence on having at least a survey

knowledge that's comprehensive of a field. So, for example, compared to other programs,

we were had extensive survey courses in bridging from Egyptian medicine,

ancient Egyptian medicine, through medical institutions, diseases, professionalization and so forth.

And I think that's a real strength as I look back in my training. And that comprehensiveness carries

over to his scholarship. I'm sure many of you know his books, the Enlightenment Hospital in

18th Century Scotland. I may have reversed a few words in that title, [Hospital Life in Enlightenment Scotland]

and his more recent book on hospitals. They're characterized by extensive use of primary sources,

drilling deep into an archive and allowing in general narratives to

emerge from those archives and then

flushing out those narratives with all

the historical factors and cultural values that inform those histories.

So it's a very breathtaking kind of history. It's a history that's informed by his

training at the University of Chicago. After that, he was at Wisconsin for

many years and was recruited by UCSF to be chair of the Department of History

and Philosophy of Medicine there. For the past several years, he's been in retirement near Seattle.

But retirement for Guenter doesn't mean inaction in any sense. He still remained very productive

as a scholar, and today we'll be talking about a fascinating story in the history of San

Francisco as a piece of urban history, and also in the history of community

organization and community responses to disease. It's something I know a little

bit about from having hung around with Guenter all these years.

So without further ado, Doctor Risse.

[ Applause ]

Thank you very much, Robert. I'd like to thank the organizers of the meeting.

I was coming over to go to the National Archives and I thought I

would like to present a little bit of the research that an NIH grant,

NLM grant gave me. My officer for my grant is sitting

there and so I'd like to thank the National Library of Medicine for

making it possible for me to have a grant as a retired person.

Independent and being able to continue some of my work.

I think that what I'm going to be talking about today is,

is part of it's a story that and Doctor Mortensen alluded to that already.

It's painfully cobbled together because I've been doing always

18th century history where there are very, very few sources available and you

sort of have to kind of put very teensy little pieces together.

And this was kind of true for this story, which is coming, coming out for the very first time

in history, because it hadn't. It has been in a Chinese newspaper

and it's been translated and analyzed

in the last couple of months. And it also is kind of timely

for us today because it deals with religion and race, which is which are two of the

pivotal factors that move our society as well as many other societies.

And therefore it's a

kind of a story that speaks to the importance of of creating institutions

and illuminates aspects of cultural division that we are

still grappling with to this day, as well as the development of

the modern Caucasian. I want to call it a hospital for

which I have written a lot on.

So I think we already have it.

OK good. I'll put a few slides up so that

you get a sense of the place.

There's always we can talk and abstract, but it's a sense of the place.

This is Chinatown, the entrance of Chinatown 1900.

It is a many of these are faded pictures,

and then others I have from Getty [Images] and other photographers who went into

Chinatown and took these photographs. By the 1870s,

the American hospitals began their transformation from charitable

shelters to truly medical institutions of first resort.

This under the patronage of religious and to lay communities.

These establishments experienced very dramatic changes in their mission.

Being in it no longer was just to kind of keep somebody comfortable

but to kind of vigorously begin

to attack the disease and to

try to get get recovery on that. Unfortunately,

in a in a display of of of blatant racism,

the Chinese patients were excluded in the City and County Hospital

of San Francisco since their ailments were considered at the time to contaminate as it were.

There was the word the civilized citizens of of San Francisco.

This was particularly true for the prostitutes who suffered from advanced cases of syphilis.

And only during epidemics, sick Chinese living in San Francisco

were forced into special isolation facilities created by the city

for smallpox and leprosy victims. Now, efforts by the Chinese community

leaders to create hospitals and dispensaries in Chinatown were stymied

by a reputation that persisted until close to the end into the 20th century.

And that is the Chinese sponsored something which was called.

This is by the way as a photograph of one of the streets in Chinatown

that led for the pest hall designation that the city had it.

It is the garbage collection was optional in San Francisco and the Chinese

some of the the streets were so narrow that the carts could not get through them.

But the Chinese had a particular

peculiar organization that is called the "hall of tranquility."

It is, it's it. There was many of these around in the district.

They were called also small hospitals, but there were really basically shelters.

Shelters were which functioned as nursing facilities for the very sick.

But more often there were actually stations for the dying.

There were there were hospice like kind of institutions, these individuals that were in there.

This is an exterior of one of them

and you can see an inside drawing

of this woman and a close up of her. These were,

they were actually the Chinese Consolidated Benevolent Association

which was called the "Six Companies." That's a merchant association. They had a big,

"Hall of Great Peace," which was a hospice like institution.

And so did many of the local funeral establishments or "coffin shops" which

were equipped with dark rooms and you

can see a drawing in a newspaper. These these dark rooms were had cots

they were placed near the open coffins. So death was regarded as a welcome

visitor and it is often self invited by an overdose of opium,

wrote one of the Caucasian newspapers. But that you get an idea from the

drawings and of course the San Francisco press was very try to be very

sensational about this and and doing. But the practice of removing incurable and dying individuals

to set establishments was then totally abhorrent to the Westerners.

And the reports of abandoning the seriously sick without bedding, without food and nursing care,

together with a horrifying mingling of the living and the dead,

became a very powerful argument for branding the Chinese as heartless monsters,

in Chinatown.

In turn, the China Chinatown people spoke in the same language that

the Caucasians were talking about, about their Halls of Tranquility, about the city and county

hospital. It was called-- they spoke about it as a deathbed care in the city hospital.

They expressed their preference to stay and die among their own people,

and the ordinary Chinese distrusted this Western medical practices

and only the wealthy sought care from Caucasian physicians in certain emergency situations,

especially during pregnancy and childbirth.

By 1875, newspaper editorials had suggested that leading Chinese

merchants should follow the example of Hong Kong and Macao and establish

a central hospital for the care of Chinese patients. In Hong Kong, they existed already in autonomous

all Chinese committee of prominent businessmen that were living in the

British colony and they founded the

Tung Wah Hospital in 1869 to counteract these this negative publicity,

which also happened in Hong Kong about the conditions in these dying

halls or hearts of tranquility. This institution was designed as a

shelter for relief and protection of the primary ill, the one in Hong Kong

and some destitute emigrants that were streaming from Hong Kong into Hong Kong,

from Southeast China. The institution was autonomous it

doesn't have any Western interference, at least not for many, many decades,

and the hospital was operated according to Chinese medical principles,

with native practitioners dispensing popular herbal preparations.

Although this model was appealing, the San Francisco authorities opposed

the erection of new hospitals and crowded and tainted urban districts,

breeding disease like Chinatown was. It was a world then, in the 1880s,

that was still clinging to all the traditional notions about the

dangers of miasma and contagion, and the hospitals needed to be placed in

settings that were endowed with fresh air,

ample sunshine and little noise.

Nevertheless, an attempt was made

in 1888, to follow this Hong Kong example

with a sponsorship by local Chinese diplomats and merchants.

The original plan called for a staff of Chinese practitioners,

with a Western physician likely to be retained for possible contingencies.

Now, unfortunately, both the location and the staff arrangements immediately doomed this project.

The future neighbors protested, saying that they're suspected that

the Chinese would likely smuggle contagious cases into this new hospital to avoid detection

and sending them to the pesthouse. The previous smallpox and leprosy

cases were always hidden in languish and in Chinatown's notorious halls.

Unfortunately, my voice, after five days on the road, is quitting us. So I'll have a

[ Water slushing ]

Now they, the city insisted that the Chinese physicians would have to

acquire Western medical principles. This is an era when gradually science

begins to get into a hospital. And they insisted also that they pass an

examination of their California license.

This photograph is from the Chinese consulate,

and it's important because in 1890, Ho Yow, who was the new Chinese

Consulate General in San Francisco, together with the presidents of the merchant companies,

purchased a parcel of land in the southern outskirts of the city and actively began collecting

subscriptions for a Chinese hospital. Before construction could start,

however, the city authorities again stopped the project on grounds that the sponsors only intended

to use objectionable Chinese systems of medical treatment.

The horrific reputation of the Hearts of Tranquility also remains a

powerful [?]. Fueling anti-Chinese sentiment and blocking the

creation of of such a hospital. There were series of exposes that appeared in the San Francisco Call

in 1896 and featured this revolting conditions in these places

and these hospices. And according to witnesses, decomposing bodies were frequently

laid there for days, etcetera. Ho Yow, however, remained very optimistic that he

could breakthrough this barrier. He was the son of a very prominent Hong Kong Christian missionary.

So he was a Christian, and he was attuned to the gospel of mercy

and assistance to the sick and the poor. And his father had been one of the

early Chinese missionaries in China.

He also had connection with members of the various Protestant churches and

their affiliated Western physicians. So together with some of them,

on March 2, 1899, they formed a new corporation

for the establishment of the Chinese Hospital of San Francisco.

In addition to previous diplomatic and mercantile Chinese sponsors,

the Hospital board of trustees now included other people, especially

American residents of the city. One of them was Boudinot Atterbury.

He was a former Presbyterian Mission medical missionary who had just returned up to 20 years in China

and where he had established a small hospital in Beijing.

Now the dispensary was to give that he

wanted to set up--- Ho Yow wanted to set up this dispensary to

give free medical advice and medicines to all outpatients who needed them,

and it would have possibly some inpatient facilities.

However, the plan required that only practitioners of American or European

medical licenses would be allowed to treat patients because he was trying

to accommodate and get through that that opposition by by doing that.

But this was a radical departure from the previous schemes and

hoping to garner official approval. He then paid the price because

the institution was created. But within a few months,

few members of the Chinese community were willing to seek assistance

from a Western trained physicians. So the hospital went went under.

Here's a view of of one of the this

is Ho Yow's wife and child, there were OK, somebody photographed them as they and

they're very seldom left Chinatown. If they did, they did it in a carriage. But---

Yow actually left his two daughters

in China and with his parents and brought only his wife

and his young son with him.

So in in spite of all of that the

what was going to happen here? There were again they made another

effort in early 1900 and this time Yow

put $1500 down to as a contribution to

establish it now and he put the name of the the one in Hong Kong, the Tung Wah,

which means East China or Oriental Dispensary.

And the plan was to locate it in a rented house in Chinatown.

Now using the this Tung Wah name was

represented a very clever strategy to make a new institution much more

acceptable to a range of Chinese migrants who had received some

services from the Tung Wah in Hong Kong.

And. But there's evidence that his model

for Chinatown's dispensary I was checking

into that it was actually not the Tung Wah, it was only the name they took from that.

The model for this hospital was Hong Kong's Alice Memorial Hospital,

which was an institution that had been founded in 1887. Under the auspices of the London

Missionary Society, with a very generous support from Ho's family.

Especially his older brother Ho Kai, who was an 1880 medical graduate

from Edinburgh University. With the with efforts then to integrate this time Chinese and Western

medicine already visible in Hong Kong. The Chinatown establishment plan

to operate with a mixed staff this time featuring several western

trained physicians mostly linked to the local Christian churches.

And here's a photograph of the in

the this is actually the quarters of

the his private quarters next to the consulate and you can see the the

the splendor is always in the upper floors and Chinatown where where

the more richer merchants live. So it's a kind of a thing like in

Edinburgh used to be in the 18th century, that the lower you get in the

basements there, the lower people, and then the higher you get, the more money you have.

But they all live together as a community.

And so here's a

here's another photograph of one

of the merchants sitting in a

hall in a hall in these are from meeting halls that are next to the

to the living quarters of the. And this is actually the a drawing

that appeared in the newspaper of the Oriental as it as it was,

as it opened up. And the

dispensary wanted to have both

these Western and Chinese doctors with some nurses that were on that

kind of staff and the leadership pledge that they would do their best and help patients and so forth.

And the Call, the San Francisco Call would publish this with a

drawing of the room and the and the can see have a sketch of how one

of these rooms look like and then some of the medicines put in there.

And this is on Sacramento Street and

this is supposed to be the matron head nurse that the hospital would have. [ Audio improves ]

The publication of course the

the San Francisco Call welcomed this

and was very laudatory that finally the Chinese were achieving a

certain legitimacy and there was willingness to work with the within

the San Francisco establishment. The hospital was placed under the direction

of a western physician and surgeon by the name of George L. Fitch who was

already practicing in San Francisco and counselor Yow knew Fitch who was considered

an expert on leprosy and syphilis. 2 Diseases that were prevalent in many parts of China,

including Hong Kong, of course. Originally from New York and a graduate

from Bellevue Hospital Medical College, Fitch would boast a 30 year career

in clinical and administrative work, mostly in Hawaii, where he had distinguished himself

caring for natives afflicted with leprosy and dispensaries,

hospitals and at the settlement on Molokai. Fitch was assisted by Atterbury,

who we already mentioned, and Ernest A. Sturge who was also a missionary physician.

Originally sent to Thailand by the Christ United Presbyterian Church,

he was a graduate from the University of Pennsylvania who had returned for

health reasons and was assigned by the church to assist the local Chinese.

Both Atterbury and Sturge were responsible for internal medicine and other diseases.

Also featured was Gardener P. Pond, who was a 32 year-old son of a clergyman

who headed the Congregational Church in San Francisco.

Pond had graduated from the University of California Medical Department,

specialized in ophthalmology and otology. And lastly, there was Minnie G. Worley.

A graduate from the San Francisco's Cooper Medical College, who specialized in pediatrics

and gynecology and was also attached to the Christian Missions in Chinatown.

Single, Worley lived in the center of Chinatown.

I looked her up in the Census 1900 census.

Thus then, all Western medical staff members were either former

missionary physicians or professionals with close ties to the Ministerial

Union of Protestant churches, who combined the mending of bodies with

Christian efforts to save their souls. Their empathy and experiences had brought

them closer to the Chinese population, and some of them developed an

interest in native healing methods, including acupuncture and the use of herbs.

And dispensary advertisements which appeared in that newspaper I mentioned.

Western professionals were held in high esteem and usually referred with

a transphonetic term, Duda, for doctor, while the Chinese members continue

to be called the equivalent of Mr. in the traditional Chinese context of a learned, education,

educated individual. This variation and designation came

to reflect a racial distinction as well as an adherence to separate

medical knowledge systems. The Oriental Dispensary opened its

doors at this place in---

828 Sacramento Street on March 3rd, 1900. This group photograph.

This is an advertisement in the

Chinese newspaper indicate from the very first issue of that newspaper there was

daily the newspaper editor put a just large ad in there with which lists

all the doctors that times of their appointments when they have hours,

visiting clinic hours etcetera etcetera. The editor was also a question.

[?Nam Pong Chu?]. It opened then on March 3rd, and that was the 4th day,

or the second month according to the Chinese calendar and astrologically

considered to be an auspicious day. But unfortunately,

it was three days before the plague allegedly was discovered in Chinatown.

Conceived as a small community institution primarily for treating the sick poor,

the San Francisco Tung Wah here was restricted to serve patients that

were currently living in Chinatown. Those able to pay were expected to

contribute to its support and counselor Yow acknowledged that the establishment was not a hospital

in that strict sense of the word, but rather a place where Chinese suffering

from an ailment could be promptly treated. At the outset, the dispensary equipped with medical

supplies that were donated by prominent medical Chinese merchants and was to

provide exclusively outpatient medical care and free medications for the poor.

Emergency admissions where possible. But no beds were to be provided for

patients with conditions that suggested a long term stay. For that purpose then

Fitch occasionally boarded at the dispensary.

He lived outside of Chinatown for

after hours to take emergency calls.

And there is a---

this photo is the photo and as you've

seen on the poster this photo is not

possible to identify exactly and in time some believe that this photograph

was taken after the earthquake and

and in their newer location. Because it looks the the columns there look

a little different than the sketch that appeared in the newspaper.

But you can see here that there are all these in the front that have

these numbers on Chinese nurses and and practitioners and then on the top

the other two, this individual. These three individuals are the physicians,

the Western physicians.

The register and receive services and free medicine. All poor patients visiting the dispensary

or in need of a home visit needed to furnish a letter with their name

and address stamped by their landlord. There were no appointments necessary but and the consultations

were made on a first come basis. The Tung Wah made arrangements with drugstores

in Chinatown to dispense medicines. In order to avoid confusion, the patients were urged to get

their drugs from the shops approved and listed by the institution. There were no popular tonics

that would be prescribed. The doctor's prescriptions required the clinic's imprint so that the

drugstore could provide the medicines accordingly to that. Without the stamp

note the patients needed to pay. Due to limited funding, the dispensary first only provided

these outpatient medical care, the medicines and on May 1st, 1900,

the China Daily published the names of Chinese individuals, associations and and merchants who had

pledged contributions to the Tung Wah. There were 54 donors listed in the newspaper,

arranged according to their social status in the community. Leading offers, of course,

the Chinese ambassador in Washington and his brother-in-law,

which was counsel for Yow and his spouse. They were followed by 6 companies and a

number of other regional associations, stores, individual merchants.

A total of $11,000 silver dollars were raised in two months,

and the dispensary appealed for

more enthusiastic, as they put it, donations. Although the more attuned to

Chinese needs than previous institutions of this kind, the Tung Wah was almost immediately

affected by the announcement that the bubonic plague had arrived in Chinatown. And

he is by the way, an advertisement

in the Chinese newspaper for one of

the Chinese physicians practicing

practicing in the Tung Wah gave these individuals a standing that

they did not have prior to that time. In fact, they were being constantly

harassed because they didn't practice medicine without a license.

But being under the at the staff of the

hospital provided some protection to them.

So the problem, of course was,

when the plague came in, the early isolation measures,

immediately hampered the Western nurse, the Western staff members from

caring for the dispensary patients. Fitch was forced to request special permission from the health board

for crossing police lines, and his request to enter the quarantine district

was initially even denied by a member of the health board. But legal threats allowed him

eventually to and others to return. After four day quarantine was lifted of the of the district.

But following the first plague case, the dispensary was notified about

a new health board regulation that demanded that physicians attending Chinatown patients needed to

report all their serious cases promptly to the local authorities. The practitioners were enjoined to

prepare detailed clinical histories of those that they cared for. And in case of death,

no bodies could be all bodies had to be subjected to autopsies. Now,

this new rule covered all physicians working at the Tung Wah, and less than a week later,

the health board even decided to reject all future death certificates that were issued by the

Western physicians practicing in China. We're making it enormously difficult

to maintain their practices there. But a suspicious case had been certified

as dying of cardiac condition and that the health board in San Francisco

insisted it was a plague patient. And they decided that this compliance with this rules begin

to marginalized the professional authority of the Dispensary physicians.

And it damaged more also their relationships with Chinese patients

who already distrusted and feared Western medicine to begin with,

but who now became increasingly more concerned because of the problem with plague.

The authorities now insisted on postmortem dismemberments before issuing death certificates.

Autopsy and cremation were particularly feared, and they were vigorously opposed

by the Chinese Chinatown dwellers because in their religious conceptions

it left the souls of the departed haunting the living, while the loss of their bones

prevented their burial and ancestor worship in their homeland. Fortunately,

Yow's attorneys managed to renegotiate and reach a new accord with San Francisco

health authorities. The Chinese, the only way that they could reply

to these kinds of pressures was with high paid lawyers, Western lawyers.

All seriously ill Chinese would be referred to the dispensary and the death would be then jointly

examined by Western physicians and the San Francisco health officials.

But there's no clear evidence of an infection disease, it would emerge there would be

no autopsy and cremation. They put a stop on that in some extent.

To deflect the possible institutional boycott from the sick Chinese. The dispensary announced 2

days later after this. This passed past the this announcement

of the San Francisco board by having all indicating that the Western staff

doctors were all still willing to visit Chinese patients in their homes.

[ Paper rustling ]

While Fitch's empathy with stigmatized Hawaiian lepers

may have been favorably impressing the Chinese leadership,

his medical credentials were suspect. And in an article that he published

in 1885 in the Pacific Medical and Surgical Journal, Fitch argued that leprosy was

non-contagious and that it represented a fourth stage in the evolution of

venereal syphilis. Promoted in the midst of a bacteriological revolution, and the Norwegian Hanson had

already isolated the Mycobacterium responsive for this disease in 1873.

This hypothesis brought ridicule and forced Fitch to resign all

his official posts and prompted his departure from the islands.

With Fitch's wobbly scientific reputation, the Chinese of course,

turned now to a fashionable San Francisco physician with up to date

pathological and bacteriological credentials. His name was Ernest S. Pillsbury,

and he became then the new point man in this battle to challenge all plague

diagnosis and to discredit other experts. But almost from the start,

the local and federal health officials began to openly criticize the Western

physicians operating in Chinatown, including those that staffed at Tung Wah.

Before the March opening, one newspaper had characterized the most prominent physicians of the city.

Since American physicians were generally ignorant about Asian pathology,

the opinions of those that already practiced in the midst of should be

respected. But the effects that unfolded. They were accused of failing to

notify the authorities about presumed plague victims. They were were accused of falsifying death

certificates and in a few instances, deliberately destroying the evidence that

could have led to a plague diagnosis. Joseph J. Kinyoun, who was the increasingly frustrated

federal quarantine officer in San Francisco, even called them vampires,

engaged in their work simply to earn a living, doing everything to curry favor

with their paying clients. Mutual accusations of bribery flew between partisans of the San Francisco

Health Board and their detractors, including several Western physicians. In Pillsbury,

the pathologist they consulted for the Chinese, even went so far as to

accuse Kinyoun of fabricating evidence needed to justify the Chinatown

quarantine by giving city bacteriologists cultures of plague bacilli that he

had bought obtained from Bombay, India. You can see that the,

the gradually the tone of that kind of thing goes goes off.

Here's a photograph that I should have probably it's actually a drawing.

This is Chinese herbal shop in

in Chinatown where some of the Tung Wah outpatients obtained their

their medications from. And this,

this of course is the

the person that these these are all supposed to be germs that are

flowing around this San Franciscan who seems to be baffled and

bewildered by by this new plague coming into the picture.

Well, by March 26th, 1900, in the midst of an inspection and cleaning campaign in Chinatown,

the dispensary announced that it would provide outpatient services and medicines free of charge for

five days to all impoverished Chinese patients to complete their recovery.

And the Chinese documents revealed that the admission at that point of inpatient facilities required

affidavits of support and stamps of insurance from previous employers

or lodging places and so forth. But the offers were designed to stem

the exit and removal of fearful and sick district residents who were

fleeing in droves across the Bay to escape detection and detention. To the dismay, of course,

of the San Francisco health authorities.

This is the infamous or famous Globe

Hotel in which the first so-called

plague case was discovered and which triggered then a four day initial

quarantine of Chinatown and initiated a battle that lasted over four years.

By May 15 in Washington on May 15, 1900,

Surgeon General Gral Wyman suggested the

establishment of pest hospitals in Chinatown. A notion that was supported strongly by by Kinyoun.

The doctor's recommendation was based on the discovery of four new cases that

had been diagnosed with this disease. Because of legal threats from the Chinese leadership,

the efforts by the city authorities failed to convert the dispensary

that I'm talking about into a true Chinatown detention Center for potential plague victims.

Here's a photographic a drawing in the newspaper about.

The core down sanitaire they they where all the you know all the

people looking and this is Chinatown it actually is a drawing of the

Globe hotel and you see there the policeman creating a lines here

that couldn't be crossed.

So the problem then was that here

we have a institution that is trying to struggled through this plague but

every as the antagonism between the various parties gets

bigger and stronger and much more meaner and our lawyers get

into the picture. The hospital is struggling with with its existence

it's sort of a marginalized. By June of 1900 there were new health

regulations that now demanded the names and the addresses of all sick

Chinese to be immediately reported to the health board before a physician

was even allowed to see or treat them. And the board Physicians would have

exclusive rights to examine all deaths 6 hours before any other practitioner could receive access--

And or to the remains. By this time,

several Western members of the Tung Wah staff were prominently involved in protested was staged by the

Protestant clergy and other local practitioners who who supported the

Chinese and their struggle against the another threat of quarantine.

As early as May 1900 they were Christianized Chinese that were affiliated with various missionary

churches circulated a statement of solidarity among the pastors and the

parishioners of San Francisco concerning the plight of quarantine Chinatown. Thanks to the efforts,

there was a committee and two of the female obstetricians that I mentioned. One was Minnie G. Worley.

There's another one, Lydia Wyckoff. They were appointed to investigate the plague.

And they tried to interview Gage, the governor of California,

Kinyoun at the federal quarantine station, and members of the health board. But they're pleas,

and their opinions that fell on deaf ears.

They were not really listened to.

By the end of the summer of 1900, the political pressures that had been exerted by the mayor had

forced the Tung Wah leadership to allow the admission of Chinese suspected

of being exposed to plague for temporary observation and quarantine. Which was a very significant

concession because it really made them into a plague hospital. Fitch refused to believe in the

existence of plague in Chinatown, and then his diagnosis continued to challenge the local and

federal health officials. There was an agreement worked out between

the San Francisco health officials and the Marine Hospital Service, and which the federal feds were

given the exclusive power to issue a freedom from plague certificate.

And without it you couldn't bury anybody. So that of course is very difficult here.

The Chinese want to be buried temporarily in in in the Chinese

cemetery and then their bones would

be dug up again and sent to the homelands. The fiercely contested plague

diagnosis contributed to a growing distrust of Caucasian medical

practices among the Chinese. For them, the traditional image of the

Western type hospitals was already one of segregation and death,

and now increasingly more western-oriented Tung Wah came to allow the practice of

autopsies on most diseased patients, which was a procedure that was strongly

resisted by the Chinese and cultural grounds. So originally conceived as a

bridge here between charitable western and Chinese interests, the dispensary was being severely

tested by public health politics and conflicting medical views of plague.

So we go then into a period of

time when there's an isolation.

Chinatown becomes again detention center,

largely because the new cases apparently come

up with plague and more studies are done.

And this secretary of the six companies

is refusing and refused again to have the

Tung Wah officially declared a plague hospital. He said he couldn't fully understand

the need for that institution. It clearly was a plan of colonizing the district with western medical

facilities including autopsy rooms, and perceived by the Chinese as an

intolerable intrusion into their institution. Fortunately, the city was always stingy

about funding health related measures and then failed to provide the money.

And this other new proposal was also shelved.

I looked at the statistics from the Chinese Mortuary records at the city and

county of San Francisco and they revealed that the first official death in the

dispensary occurred there on May 15th 1901. So all that period before that

they were just having outpatients,

and for 1901 there were 392 Chinese deaths listed in those records,

but only 11 occurred in the Tung Wah, so it came at the very end of the year. However,

the Board of Health and the and the Federal Marine Hospital Service reaffirmed their

right to employ the Oriental Dispensary for admission isolation of plague patients.

Yet during the next four years the institution managed to play a minor role in the epidemics,

only admitting 6 out of the 119 official plague cases.

It was pretty clever to avoid that kind of stigma of having plague

in their in their only hospital. One of them was that the first one

was a grocery clerk that came in 1901 and he was brought in

the case he had a suspicious bubo

and it was clear when the when

the health authorities came in. This

case was clearly a plague case but

the patient was refusing the removal

of a specimen get a little sample from this bubo and took it.

They then they organized the plot in the hospital to smuggle the patient

out of Chinatown to Sacramento Ranch and that was uncovered because one

of the janitors prompting kind of told the police about it.

So the whole hospital was put under strict guard and until the this

individual actually recovered from the plague and was discharged.

The staff began to change.

It was clear that some of the early missionaries had other duties

and kind of moved off. There was a homeopathic physician

that replaced Doctor Pond and then Lydia Wyckoff came in.

So we had two women now in their pediatrics and gynecology and

doing a lot of birth of

wealthier Chinese merchants.

After the inauguration of Mayor Eugene Schmitz in January 1902.

There was there were three dispensary patients that were all diagnosed by

Fitch as suffering from pneumonia and it that created another big route.

Fitch was being paid by the Chinese companies, of course. He applied directly for Bureau of Permits

and they were refused by the by the San Francisco authorities who

kept Fitch on a on a short leash.

In 1902, they were faced with complaints that were filed in the

Foreign Office in Beijing about his consular duties. So consul Yow

defended himself by stressing that one

of his main accomplishments was the Tung Wah, that he had not only claimed to

be the original founder of it, but it was also its main contributor. And by then, however,

and this is the paradox of that, that encounter, the dispensary

had amassed $30,000 in endowment, having treated 12,000 patients

during the last those two years. So there were a lot of people coming

through that ambulatory service.

You see that those are the customers of the of the Tung Wah.

It's a photograph on Getty [Images] of one of the Chinese streets.

It's a it's a kind of very strange to see that it is 90% male.

There are few women that there were very few women living in Chinatown but and they're

all in their homes. So the only people out in the streets are males.

It's a very famous photograph of that.

And the news about anything including

the plague is very easy to to read them because they were all posted,

including the Chinese daily was posted on the streets so people could read it instead

of having a subscription to it.

Another another close up of that.

Get a little bit of a of a flavor. This, these are the precisely the

problems that I was talking about.

It's trying to slip the patients out of like they wanted to remove the

person out of the Tung Wah and put him in take him up to Sacramento

ranch you know with a lot of smaller Chinese fishing villages up there.

So I want to end this moving is

goes on the rooftops occasionally there's a drawing from some Caucasian

newspapers about how that took place.

I could talk a lot about about the patients but I don't think that's very interesting.

The important thing is that the Tung Wah

tried to function more and more as a

Western Hospital because it did the

autopsies there and they continued, there were a lot of suspicions

that it became a house of death. And so gradually there there was

and that kind of thing happened

largely because the Chinese that came

to it many of them had tuberculosis and there were they came in the

latest stages of tuberculosis. If you go through the mortality

records the from the city and county of San Francisco you realize that

more than 50% of the diagnosis where tuberculosis of the lungs.

The one of the things that

that kind of set back I said they had

created a big endowment for themselves. But in in October 2000 not only

was that a large endowment but they I got additional donations. So they must have been popular among

a certain group of people within the Chinese population. They got a new donation,

$10,000 and they used it to purchase another brick building in

Chinatown as an investment with the monthly rental income towards them

covering the hospital expenses. Unfortunately, because of the popularity with certain

levels of Chinese in San Francisco, the dispensary monthly operations

ballooned to more than $1000 a month and

they became very worried about that. So to ensure the long term financial survival,

the hospital drafted a policy that required minimum payments

by all patients coming to it.

Now there are some that donated $10 each time that they're consulted,

but---

Tung Wah in 1902 had become, however, a model, and it was

touted as the foremost charitable establishment for overseas Chinese.

Leading to efforts then to establish a similar institution in New York.

More staff changes in 1903, brought some other practitioners into that,

so they diminished this Christian connection. One of them was Edward Selzer,

who was a New York doctor with good connections to the local

and the health authorities, the federal ones.

And so in 1903 the mortuary

statistics that I looked at indicate that out of 431 reported death,

120 of them occurred in that institutions. It had become a house of death.

And that's an--- it's 27% and half of

these were the pulmonary tuberculosis. The Chinese Daily printed

a notice that the dispensary physicians that had been replaced now

by the new cadre of of Westerners were cooperating with the new sanitary campaign launched by the

health authorities through Chinatown. And so a combined federal,

state and local operation was carried out to clean Chinatown with the

approval of the Chinese leadership. The doctors were supposed to be part of an inspection team that

advised on the removal of dilapidated business at basements and houses.

The last official plague case was seen

at the hospital was in January 1904. Fitch issued his last dispensary

death certificate on April 21st of that year and died on June 2nd.

And he was replaced by Fitzgibbon, who actually was a graduate from San

Francisco's Cooper Medical College and had been a member of the San Francisco

Health Board in the late 1890s. So he was a prominent local physician.

And he it would appear then that with the with Khan and Fitzgibbon and Seltzer,

the Tung Wah was moving into a much more amicable relationship with a

local health board and with members of the US Public Health Service

that was stationed in San Francisco. This would have mirrored then also the

increasingly much more conciliatory stance that was adopted by the Chinese

leadership towards the clearing of Chinatown and contrasted them very

sharply with these earlier contentious dealings during the Fitch era. In 1904,

turned out to be another good year for the dispensary in terms of action.

There are 390 Chinese death in the mortuary records. 109 were recorded as dying in the

establishment, still around 27 28%.

Not much is known about events after during 1905. There were only

208 Chinese deaths listed that year, entire year. And no more further cases of plague.

Only 45 deaths in the Tung Wah hospital. Unfortunately,

the building housing the dispensary was totally destroyed by the

earthquake and fire of April 1906.  As the reconstruction ensued, the institution was recreated in

another facility that was located outside of Chinatown, where it continued for a while at Trenton St.

It would continue to dispense medical services until the creation of the new

modern Chinese hospital in April of 1925. So in summary, I don't know whether there's

another photograph. [ Blank screen ]

I want to summarize then saying that the

traditional Christian ideology of charity and the emerging scientific character,

Western medicine played critical roles in the genesis of this first Chinese hospital in America.

Both the principal sponsors and the Western medical staff were closely linked to

local Protestant missionary institutions. Many of the attending doctors already could

boast previous associations with sectors of the Chinese population they developed

during their own missionary series. Sponsorship of a dispensary staffed by a

mixed Chinese American personnel exemplifies such experiences of mutual respect,

empathy, and exchange of healing methods. Unfortunately, the [?plagues?] appearance of the bubonic

plague in San Francisco Chinatown severely hampered the success of the

institution as a model for East-West

accommodation and medical integration.

As heavy handed public health

measures spread fear and panic among the Chinese, Chinatown's population came to further distress

scientific medical practice. The Westerners attending at the dispensary often found themselves

excluded from the district, as I mentioned by quarantine [?] and

subjected to harassment by local officials. Being in the employ of the Chinese

became a stain for public officials who wish to intervene with force and

speed to avoid an epidemic disaster. The Western mercenaries, as they were called,

serving the Tung Wah, where unwelcome and uninformed turncoats.

Since plague demanded an advanced level of bacteriological knowledge and

very precise laboratory techniques, few Western physicians practicing

in San Francisco were qualified to make accurate diagnosis.

Yet in spite of all these difficulties, the Tung Wah dispensary set a precedent for

future Chinese assimilation and gradual adoption of Western medical principles. Thank you.

[ Applause ]

Questions? Yes.

[Audience:] Could you say a little about the

about the demography of. Could you say a little bit about the

demography of of plague in San Francisco? How much how many plague victims were

actually in or from Chinatown and

as compared to other areas of the city?

[Guenter B. Risse:] Well, the official record of the US Public

Health Service indicates that over the period of four years from that first case in 1900.

To 1904 April 1904.

There were 114 cases of plague officially diagnosed that way,

of which I think probably five were Caucasians.

All the rest were Chinese.

So and the Caucasians were traced back,

some of them of having gone through Chinatown or had some links to Chinatown.

There was at the very end, ironically though some in the Latin quarter,

which was adjacent to Chinatown. They were all Italians but the Caucasians that got the plague.

But in the first two years, there was not a single other than Chinese victim.

So that that was a disease that was thought to be Chinese because nobody

checked on the death certificate. My opinion is nobody checked on the

death certificates outside of Chinatown. Everybody was concentrating on Chinatown.

Private doctors would certainly not have written that diagnosis of plague of somebody

with a high fever or died very quickly. So there is something there.

I have a making a profile epidemiological

profile of China Chinese diseases as

they were reported from 1895 on to 1905.

And we'll see where outside of that, what how did the Caucasian

diagnosis may have shifted. I suspect that there could have been

plague in other places in the city and they were not officially recorded.

They were just, you know, they're under typhoid fever or some other kind of fever collapse.

You know, that kind of these death certificates are are sometimes very, very vague.

People just do kind of just look, look at the patients. Oh, this, this looks like coronary.

[ Laughter ]

[Jim Harrington:] All right. Thanks. That's very interesting. Jim Harrington from the

Fogerty International Center. John D Rockefeller invested heavily

in Beijing and the Peking Union Medical College about that same time period,

I believe in the early 1900s. I wonder if it's Standard Oil business in California.

Did you see in your research any investments by the Rockefellers in the Chinese in San Francisco,

in that area? [Guenter B. Risse:] No, no.

Yeah. Well, can you press just one note when you can you press

the button in front of you? [Audience:] From from the Chinese advertisement

I can tell, I believe that is there

during the Qing Dynasty in China. Well, I think the China

went through a revolution, their new dynasty established 1911.

I'm wondering that China Changing

Dynasty has anything to do changing the hospital in San Francisco?

Because they're the changing dynasty changing China's perspective,

the world perspective of China. So I'm just wondering do

you cover that after 1911? [Guenter B. Risse:] No, because the,

the last case of plague in

Chinatown occurred in 1904.  And then there was the earthquake.

Everything was destroyed. And when reconstruction began,

not only of Chinatown but of San Francisco.

When the plague appeared again in Chinatown, in not in Chinatown.

In San Francisco in 1906, seven and eight, six,

probably--- not 6,  7 and eight. There was not a single Chinese victim.

All the the plague cases from

that epidemic were Caucasian.

So the owners all the.

The feeling that this was a Chinese disease could not, was no longer as sustainable at

that point because the others were all there and no one,

nothing in Chinatown was happening.

[David Cantor:] Martha first.

[Martha:] Thank you. I had two questions, one about the politics of the time, referring back to

one of the editorial cartoons you showed us. And the second one about the medicines

that were distributed at the dispensary. The one was, just what do you know about those?

And on the other side, if you had looked at Chinese medicines, that would have been advertised in the

papers of Chinatown as a contrast? Let me just tell you to go back to the first question.

The editorial cartoon I'm interested in is the one where the San Francisco

man is beleaguered by these serpents. And it looked to me like the serpents

had names on them and particular faces. So I'd like to know a little bit

more about the political context.

[Guenter B. Risse:] We can go back to.

I think it is it is a political cartoon and the names cannot.

If if we turn the lights down a little bit, [ Walking of microphone ]

you can see that these are here is one for instance

this one is is Doctor Kinyoun. ---Kinyoun what? What is it? ---This one here is,

is Buckley who's another member of the health board. And then this is of course the

Federal quarantine officer. This one is health

officer. Yeah, this is just and this one here can read that very well.

Maybe you can read it from there, but can you read these too? No, I can't. --- [?] McCarthy, I think?

---Yeah, McCarthy was another health member of the health board. So.

So he's being assailed by the health board members that he

had appointed who are now suddenly telling him that there is plague in

San Francisco. And this, this is the poor San Francisco doesn't know what to

do with these fellows. Because there there were obviously just you

know severely criticized for and there was a big denial and you know that part of that story,

famous story that everybody decided that there was no plague in San Francisco in the last about

three years in spite of the fact that Federal Commission comes in and [?].

With respect to the to the

medications or the herbs. I'm having someone now translate the

the ads that are in the newspaper. Because this is a small newspaper

with four pages and 3/4 of the newspaper is ads and it's how

he lives and the and the editor. So I made an analysis of the ads and it's very interesting.

He's coming from Los Angeles, so there are a couple of banks in there

they call shops and stuff from Los Angeles. And the proportion of Los Angeles

versus San Francisco begins to change very dramatically from the beginning

in February when he when the first issue comes out and by about the

fall of that year in the say October or something there Los Angeles begins

to fade and he has all new sponsors, new banks and new establishments and herbalists.

So the herbalists are by far the

largest group of people that are sponsoring him.  As as you would expect.

And I I'd like to have, I'm having somebody at the moment the

the Berkeley was having a midterm of some sort and some of the students

that are working on this summit. I haven't been able to continue that.

But I want the complete translation of the ad because the the the survey that

we've made is only how many ads are there, what kind of ads are there?

There are several other practitioners that are also advertised there and then of

course and actually [Ng Poon] Chew who was the editor. He puts this ad that I showed you

in there all the time. That's his contribution because he's part of

the missionary group and that's his contribution to maintain announce and

and he probably didn't charge the hospital or anything that was his his

his part of that, and it's in everyone. It takes a whole page of that newspaper

and some places so it plays a big deal in that newspaper. And that's the only

reason why I could get information. I mean reading those kinds of ads and a change

of staff and trying to get. The most difficult thing and you all think that this may be easy.

But let me tell you that the names of the Western physicians can only

be ascertained through a very difficult thing because they're all in

Cantonese, [?] and Taishan.

So you have to see if there is a Caucasian and and of course the

Caucasian press ignores these people. So they haven't mentioned it very much.

So you have to go through the list of licensed physicians and go into

a Cantonese speaker and have them enunciate the name and show them

the names of the doctors and see whether there's a match. So what we've done is we have a

a website at Berkeley where we're beginning to put together you know

the matches that we have we can verify.

And by the end of probably next year we'll have that and we'll build a

website with all the materials we have once the project is over because

I want the we we made it clear to the granting agency here that we in

our application that we wanted to this collection of of articles and

the access to that this newspaper articles and that newspaper and and our interpretation and the

matching and all that information ought to be on a website for other scholars

to continue that research. Because what I'm doing is really I'm

trying to see both sides of this issue.  I'm not a Chinese speaker so I cannot

read that material but I want to bring the Chinese voice into this project.

This project is a project about the plague in San Francisco. A lot has been written on it and

nobody has ever wanted to find out how the Chinese thought about it

and how did they strategize in that. In that it was a it was a very very

traumatic. And those of you that know the history of that time, this is right, The Boxer Rebellion.

This is over the big powers are in China. These people are paralyzed fear

about their families in China and what is happening to them. They're at the same and they read

that in the same newspaper when they read about the plague, that Chew is trying to inform what

they what the Westerners say they get it from both sides. So it's a, it's a very traumatic and

very difficult time. But the unfortunate thing yet is that we haven't found a voice of a witness

to that that would clearly tell us how they,

they felt their only interviews by Western reporters of some Chinese.

They went into Chinatown and talked to them, but they're very condescending and racist in many ways.

You can extract a little bit behind it and understand the anxiety and the

the terror that they were living under. But it is something that that still needs a lot of work.

And this is just sort of a very small sample of of something that, you know,

just to give a little bit of this kind of talk, it sounds like, Oh yeah,

it's just a little piece here, a little piece there, just one mention of a word there,

one little doctor here and there and it's begin this puzzle again. It's very difficult to do.

That's why nobody's done that. Everybody's going for the easy stuff. [ Laughter ]

[David Cantor:] Next hard question--- Robert.

[Robert:] This is actually an aside. When I was an intern in San Francisco General,

I guess a resident in the 70s, we had a patient with bubonic plague

who was diagnosed in the ER. A bank, a refugee from Bangladesh had

gotten on the plane and then second. The difference of course is for $0.30, we could diagnose it in the

emergency department through staining an aspirate of a bubo.

He was hospitalized and you know, $3 worth of tetracycline I

think cured his problem. But what I'm curious about as a

question is if you've drawn parallels at all between the tensions and

eventual cooperation between a community and the health department.

That happened in 1900 with bubonic plague. It happened in the late in the

early 1980s in San Francisco, very dramatically between the health

department and the gay community and public health measures to address what

was not yet named as HIV AIDS but was another epidemic and there was again

a lot of fierce political fighting.[Guenter B. Risse:] Well, it's it's it's funny that

you mentioned that because that was the thing that when I came to San Francisco in 1985,

drew me to the plague of 1900 because I saw immediately paralyzed.

In fact you get a lot of talks on that. And a journalist from the Wall Street

Journal picked up my my talks and everything and wrote a popular book

on the plague of San Francisco. That's somebody by the name of Marilyn Chase.

But it's a journalistic account of the people with the white hats and

the black hats and something you can you can read read somewhere.

But it. In fact my book. My book that I had planned to do at that

time was before AIDS Chinatown 1900. That was the title of that book.

But that did not, you know, that was, that was almost 20 years ago. I'm having the, the,

the privilege of going back to something that I started 20 years ago and now I

want to finish it and particularly with this, this addition, this, this voice has to be in it.

Otherwise there would be no balance in it.

[David Cantor:] Here, we've got time for two or three more questions.

Yeah, just a real quick one here. Oh, yeah. OK. ---This was faith.

I'll come to you.  [Elizabeth Fee:] I'm curious about a couple of things. One is,

what is the role of the Chinese Christians within the Chinatown community?

Are they some sort of leaders? Are they a tiny minority or do

they just happen to be interested in building a hospital?

And how do they relate to presumably the majority of the Chinese are not Christian?

[Guenter B. Risse:] I could answer and just saying that

the Christian missionaries want to convert Chinese to Christianity,

that's their goal and whatever else they can do to further that goal,

they would like to do it. They were a small minority but very

active minority that went into the Portsmouth square which was the

the main square in Chinatown, I mean today and to preach.

And they obviously played a very important role in rescuing a lot of

the young girls that were prostitutes. That were being abused in

Chinatown and in those bordellos and brought them out and rescued them and brought them to their

rescue mission to learn, learn, recover from their from those

that that kind of life and then become--- learn laundry or learn sewing

or some other kind of thing to become, you know useful by themselves.

So it's a it's a very small group, but it's very active group and very well connected.

And particularly here comes the Consul General who was Christian, but there's interesting,

there's a book and there were there have two voices.

One says, well, I like 2 Chinese voices. One is it why did I become a Christian

and the other one say why am I a heathen? So they're defending their positions

as to why they stay with what what they they are and it's very

very interesting to read the

reasons for that it it actually

it they make more sense and and and and but but it is a small group but

it's cohesive group and here comes this council and he's he's he's Christian

and his father was a missionary and he has that whole connection.

He's from Hong Kong and he knows the basic Tung Wah situation there since

his brother is working on that other hospitals that other hospitals are

real integrated hospital the one that I mentioned. He gave it the name of his wife.

I can't remember now I told you the name

anyway. That was that that was really the they wanted to bring the trained Chinese.

In fact that begins the whole process of training Chinese in Western medicine in Hong Kong and

and including the revolutionary for

the the revolutionaries of the 1912.[Elizabeth Fee:] The other thing I was interested

in was the the practitioners of traditional Chinese medicine. What did they make of plague?

Did they recognize it as a specific entity,

did they have a different sort of diagnosis?

[Guenter B. Risse:] Well I think they couched that in in

in terms of of hot or cold diseases

which was very common kind of it was obviously simplified

kind of version of that in the in the late 19th century and

they they actually subscribe to a miasmatic view of of things can come

down from the ground up. That's why the rats get it first because it's an

emanation and vapor coming up in terms of their their kind of epidemiology.

So they're kind of very close to the miasmatic but you know here that you

have to remember that we we are

in in this is 15 years now 15 almost 20 years in the bacteriological

evolution into it and most large most important diseases have been all

recognized but their bacteria are their microorganisms is responsible

for them. And so that the although they still go through the motions of

cleaning you know there's these I was in the archives yesterday and you're

looking at every month every week the you know the the fellow that is from

the Public Health Service sends a message a letter how to the

Surgeon General. So many houses have we cleaned and and then indicate what

the plumbing is that is faulty in every house and how that what kind

of you know 3 plumbers we had three plumbers in their repair 5 sewer

connections that were improperly placed. That kind of level of this environmental

miasmatic kind of thing. They're still going through that, but they're going through it now with

with the overlay of the bacteriology. They're saying that this is a bad bad

dirt is there that this is bad stuff but the bacteria are all in there so.

So it's it's this kind of laying on the bacteriological layer you know the

germ layer on the onto the miasmatic and they were working together.

The Chinese only have the miasmatic. They don't have the bacteriologic. They don't know any.

They have no concept of of of the of the bugs. That's why they hire people like

this Pillsbury or others, you know, to protect them.

So it's your culture or is it my culture, It's your inoculation and seeing whether

these bacteria there and the other one and everybody found out that the

most attractive way to say that this was not plague was to flog Kitasato,

the Japanese discoverer of the plague, because he had made an earlier

attempt and confused the pneumococcus with the plague bacillus.

And and so everybody was you know on the other side was trying to say

well you know people like Kinyoun and all the people from the local health board in the

US health board are working with Kitasato's cultures and

looking at his smears and and then and it's not playing because it he

made a big mistake that the you know they all had pneumonia.

So it's a yeah. [Audience:] They weren't thinking of rats

and fleas yet were they? I don't think they had demonstrated that? ---They they begin they're

beginning to to to think about the rat, --- when they were cleaning the houses and making the reports were

they killing rats specifically ---they're beginning with that. Yeah. In 1902 that it's clear

by that time they're doing rats. They're making rat counts.

They actually autopsy the cat and inoculate whatever from

the rats to see whether they have plague and they put also

the bait into all of those sewers. The rat actually starts fairly early.

I mean but in the very first encounter, of course, not

1900 that's still dubious because you know Wyman had just published a

pamphlet on the on the plague and he didn't mention anything about rats.

---You had a question?

[Audience:] Yes, I was struck by

the dilemma to do good diagnosis with the fact that

people who were I'll, whether or not they had the plague,

were feeling the need to skedaddle out of Chinatown.

And so could you elaborate a little bit more on just both both for the

sake of the patient and also for the

controlling of any sort of epidemic.

[Guenter B. Risse:] Well you know nobody can do epidemiology

unless you have some data that you can come up with and and nobody can

do good pathology and good autopsies and cause unless you have

the individuals that have it.

So this this immediate fleeing

the the place of escaping or being concealed in a different part of the

neighborhood by friends disturbs and

and prevents the the people

that are in this campaign to try to deal with this disease to have any

idea what what they ought to be doing. They they can only take the entire district.

They cannot, they cannot just select certain parts of that because they have no data really.

And what they what the Chinese do is they they let these any death,

they keep them on the undertaker for 24 to 48 hours in order to make sure

they know from their bacteriologist that there will be so many bacteria around that nobody will

ever be able to diagnose the plague but it was among all the others. Because you can't differentiate

get these cultures growing. So it makes them enormously

frustrated because they cannot really get get on to that. On the other hand,

Chinese know very well they don't want to go into all that because they have cultural and religious

factors that make them be very fearful

because they all pay when they come into into Chinatown from China.

They pay every month some dues for their

bones to be brought back home, right. That is part of your, you know,

it's like us some some of us may buy a cemetery plot you know,

when we're young or something because we like to be buried there. It's thinking about that kind of

thing and and being the the Chinese six companies has to promise them

that their bones are going back home with their with their ancestors.

So this dismemberment and

this cremation is enormously threatening and so they've escaped

there or they they hide people or they hide the dead they hide the sick or they move them around

in a very elaborate ways. There were there are descriptions about the public health officials

going in and they the Chinese propping up some dead pretending that they're

playing cards is putting a card in front of them and they're sitting on

a chair. And you know the officials go back and looking around for somebody

who's horizontal is maybe sick and they're dead are just in front of them.

You know sitting there playing cards.

So all kinds of ways to mislead

and to detour and to prevent. And that's a tremendous conflict

that that occurs and it it creates a great deal of frustration on both

sides because the Western viewers, we need that bacteriology. We need to get the epidemiological

data in order to succeed with this campaign and eradicate this disease

from the from that from the city. And the Chinese, on the other hand is saying, no, not in my,

not at the cost of my bones and my life and all the ones of my friends.

It's a it's an existential thing that's very difficult.

[David Cantor:] Well, if there are no more questions,

I'd like to thank Professor Risse for, well what is has been a tremendously

stimulating discussion and talk. Thanks.

[ Applause ]

Thanks, very much. [Guenter B. Risse:] Well, it's a, it's a work in progress.