Public Health In The 19th Century Essayist

Historical Essay

by Dr. Joan B. Trauner, Excerpted from the version which appeared in California History, Spring 1978, Vol. LVII, No. 1, courtesy of the California Historical Society

Chinese Medical Clinic in Chinatown, c. 1890s

Photo: California Historical Society

Another aspect of the story of the Chinese as medical scapegoats in San Francisco is the effect of public health policy upon the Chinese community itself. Throughout the nineteenth century, city officials were reluctant to finance any health services for the Chinese population even though Chinatown was popularly viewed as "a laboratory of infection." Early Chinese immigrants realized the necessity of banding together and providing for their own health care needs. In the 1850's they first grouped together into associations based upon loyalty to dan (family associations) or place of origin (district associations). In the 1860's, the district associations federated into the Chung Wah Kung Saw, which later became known as the Chinese Consolidated Benevolent Association, or the Chinese Six Companies. During this period, each of the district associations maintained a small "hospital" in San Francisco for use by their aged or ailing members, a facility usually consisting of little more than a few bare rooms furnished with straw mats.[55] The existence of these hospitals was in direct violation of city health codes, but local officials allowed them to operate. In fact, during the leprosy scare of the 1870's, health officers ruled that lepers should be "debarred from hospital maintenance" at city expense and that "the Chinese companies should be compelled to maintain them and send them back to China."[56] Thus, from August, 1876, to October, 1878, known lepers were housed in the so-called Chinese "hospitals"; thereafter, health authorities ruled that all lepers were to be isolated in the Twenty-Sixth Street hospital.

Not only were local authorities ambivalent about admitting Chinese patients to municipal facilities, but they also were hesitant about providing sanitary services within the Chinatown area. Dr. A. B. Stout, a prominent physician and member of the California Board of Health, testified before a congressional investigating committee in 1877 that "the city authorities undertake to clean the city in other parts, but the Chinese are left to take care of themselves and clean their own quarter at their own expense."[57]

Whenever a major epidemic threatened San Francisco, however, health officials descended upon Chinatown with a vengeance. During the smallpox epidemic of 1876-1877, for instance, city health officer J. L. Meares bragged that not only had he ordered every house in Chinatown thoroughly fumigated, "but the whole of the Chinese quarter was put in a sanitary condition that it had not enjoyed for ten years."[58] Similar comments were made at the time of the bubonic plague in 1900-1901 when nearly every house in the district was disinfected and fumigated.

In the nineteenth century medical care in Chinatown was largely provided by herbalists and pharmacies in the classic tradition of Chinese medicine. As late as 1900, no Chinese physicians appear to have been licensed to practice medicine in the state of California; in fact, not until 1908 was the Medical Department of the University of California in San Francisco to graduate a physician of Chinese origin.[59] Some Chinese of the merchant class did seek treatment from Caucasian physicians, usually for surgical care not available from Chinese practitioners.[60] In the I880's a few church missions in Chinatown also began offering the services of white female physicians for pediatric and obstetrical care. Throughout the nineteenth century, however, the vast majority of Chinese were unwilling to consult Caucasian doctors because, as one historian has noted, "the language barriers, the higher fees, and strange medications and methods were too much to assimilate."[61]

The reluctance on the part of the Chinese to seek medical attention outside of Chinatown accounted in part for their low admission rate to the San Francisco City and County Hospital and to the Almshouse during the last century. An examination of the statistics on admissions to the city and county hospital for the years 1870-1897 reveals that less than .1 percent of the hospital inpatients were of Chinese origin, whereas the Chinese population in the city varied from 5 to 11 percent of the total population. Statistics on admissions to the Almshouse disclose an even lower admission rate: of 14,402 admissions from 1871 to 1886, only 14 cases were of Chinese origin.

Obviously, the low admission rate of the Chinese to municipal facilities cannot be attributed entirely to reluctance to seek Western-style care. An 1881 article in the San Francisco Chronicle, headlined "No Room for Chinese: They are Denied Admission to the County Hospital," referred to a resolution of the Board of Health, adopted several years earlier, that had essentially closed City and County Hospital to Chinese patients.[62]

The article pointed out that in the fall of 1881 the Chinese consul had petitioned the Board of Health on behalf of an ailing Chinese immigrant who desired to gain admission to the city and county facility. Fearing an influx of Chinese patients with chronic diseases, the board passed a resolution that all Chinese patients who thereafter requested care were to be assigned to a separate building on the Twenty-Sixth Street hospital lot.[63] Apparently, this policy remained in effect throughout the remainder of the nineteenth century. A document dated 1899 noted that the City and County Hospital only opens its doors to a limited number of [Chinese] patients. The remainder of the patients are taken to the small, dismal Charnel-house established by the Chinese Companies, and known as the "Hall of Great Peace," or else to the Leper Asylum or Pest-House.[64]

Although the ban on Chinese patients at both the City and County Hospital and the Almshouse was common knowledge, city officials continued to claim that San Francisco opened its municipal facilities to the sick and poor of any nationality.[65]

Because of the difficulties inherent in obtaining care at municipal expense, the Chinese community sought from an early date to fund a well-equipped hospital within the Chinatown area. Dr. Stout, in his congressional testimony in 1877, mentioned that the Chinese desired very much to establish a general hospital and a smallpox hospital, similar to those built by the French and German communities. Reportedly, the Chinese were willing "to pay liberally and freely" to establish a hospital, with patient care to be provided by both white and Chinese physicians.[66] (In order to secure approval from the Board of Supervisors for the erection of such a hospital, the Chinese community recognized that their Physicians would have to work in conjunction with state-licensed Caucasian physicians.)

Nothing more is heard of any hospital plans until the early 1890's when land was purchased in the southern outskirts of San Francisco in the name of the Chinese consul general of San Francisco. Plans were drawn up for a hospital, and funds were collected both locally and from foreign sources. When construction of the hospital was about to begin, "city authorities forbade further proceedings on the ground that the promoters only intended to use objectionable Chinese systems of medical treatment."[67] It can be surmised that the real objections were to the proposed location of the hospital outside the perimeter of Chinatown.

In 1899, the community planned to rent a house in a "suitable locality" to be fitted up as a hospital and dispensary where only practitioners with American or European diplomas were to be allowed to visit the patients. The dispensary was to give free advice and medicine to indigent clinic patients; the hospital was to consist of twenty-five beds for use by both clinic and paying patients. The Chinese Hospital (Yan-Chai-i-yn) was incorporated under California law in March, 1899. At that time, twenty-one persons (including twelve Caucasians) pledged to become members of the hospital by payment of an annual subscription of $5. Except for the Chinese consul general, the officers of the hospital's first governing board were to be prominent members of the white community.[68] This project, too, must have been shelved because no further trace of this hospital can be found.


Dr. Trauner is a research specialist at the University of California, San Francisco, Medical Center in the History of Health Science Department.


55. U.S. Congress, Senate, Report of the Joint Special Committee to Investigate Chinese Immigration, 44 Cong., 2 Sess., 1877, p. 646.

56. "Mongolian Leprosy," 236.

57. Examination of the testimony of Arthur B. Stout, M.D., before Joint Special Committee to Investigate Chinese Immigration, Report of the Royal Commission on Chinese Immigration, 1885, p. 311.

58. Municipal Reports, 1877, p. 398.

59. Transactions, 1901, p. 386. See also "Medical School: Directory of Graduates, 1864-1921," University of California Bulletin, third series, 15:3.

60. Royal Commission, 1885, p. 224.

61. Chinn, A History of the Chinese in California, 78.

62. San Francisco Chronicle, November 20, 1881.

63. Ibid.

64. The Chinese Hospital of San Francisco (Oakland: Carruth & Carruth, 1899), p. 2.

65. "Mongolian Leprosy," 236.

66. Report of Joint Special Committee to Investigate Chinese Immigration, 1877, p. 647.

67. Chinese Hospital of San Francisco, 1899, p. 2.

68. Ibid., p. 6.

Prev. Document Next Document

Public Health

Formulaire d’Hygiène Infantile Collective. From the holdings of Center for the History of Medicine/Francis A. Countway Library of Medicine—Harvard Medical School.

Public health is a population–based concept for addressing the causes and the prevention of disease among demographic groups rather than among individuals. Experts in public health regard social and environmental factors as fundamental to understanding the relative health and longevity of particular populations. These social and environmental factors change over time—just as the understanding of diseases, their causes, and their prevention changes.

Studying the history of public health can add many dimensions to the study of class, economics, politics, gender, race, ethnicity, and religion—all of which play significant roles in public health.

Epidemics and Social Conditions

In 1848, after studying a typhus epidemic, the German pathologist Rudolf Virchow stated that all epidemics had social causes—most typically poverty, hunger, and poor housing. Virchow believed that improving social conditions would have a positive effect on public health. This important early perspective plays a significant role in today’s thinking about public health, especially when there are major health disparities among social classes within an individual society or between rich and poor countries.

Hygiene and Sanitation

Hygiene and sanitation are major factors in the history of public health. In Europe and the United States, public sanitary practices and the professional discipline of public health came of age in the mid-19th century in response to urbanization, immigration, and industrialization, and to the 19th-century cholera epidemics. Until the development of germ theory in the later part of the 19th century, sanitary practices were based primarily on miasmatic theories of disease (where disease was thought to be caused and spread to susceptible people by decaying plant and animal matter, various kinds of waste, bad smells, and bad air), on contemporary ideas about infection and contagion, and on beliefs about the health impact of personal behaviors, morality, and innate susceptibility associated with particular social classes or ethnic groups.

By the end of the 19th century, most major urban areas had sewer systems, and indoor plumbing could be found in many middle-class and most well-to-do homes. Although there had been some earlier state-based or other organized responses to individual epidemics—primarily quarantine and disinfection measures related to outbreaks of plague—it was in the period from the mid-19th to the early 20th centuries that permanent boards of health were established in many major urban centers.

Public Health, Medicine, and the State

Tensions sometimes arise between medicine and public health. Each discipline has its distinct priorities. Medicine aims at cures for individual diseases and primarily involves individual patients. Public health emphasizes the prevention of disease and a population–based understanding of its causes.

The methods and goals of public health officials are also sometimes at odds with local governments and members of the public who object to the role of the state in personal health. Within the discipline of public health there have also been differences in priority, often between lab-based or other scientific work and work that studies other factors involved in disease. For example, vaccination campaigns have sometimes been criticized for deemphasizing the sanitary, nutritional, and other social contributors to the transmission and severity of infectious disease.

The Demographic Transition

The mortality rate from infectious diseases had risen during the 19th century with urbanization. The rate began to drop toward the end of the 19th century, and historians have theorized that public sanitation and improved nutrition were responsible for most of this improvement. However, with the decline in severity of infectious disease came a rise in chronic diseases, cancer, and injuries and health damage associated with industrial labor.


Selected Contagion Resources

This is a partial list of digitized materials available in Contagion: Historical Views of Diseases and Epidemics. For additional materials on the topic “Public Health,” click here or search the collection’s Catalog and Full Text databases.

Web Pages

The Boston Smallpox Epidemic, 1721
Cholera Epidemics in the 19th Century
Concepts of Contagion and Epidemics
Domestic Medicine
Germ Theory
International Sanitary Conferences
Robert Koch, 1843–1910
Medical Geography
Florence Nightingale, 1820–1910
“Pestilence” and the Printed Books of the Late 15th Century
Syphilis, 1494–1923
Tropical Diseases and the Construction of the Panama Canal, 1904–1914
Tuberculosis in Europe and North America, 1800–1922
Rudolf Virchow, 1821–1902


Boston Overseers of the Poor Records.
Papers of Benjamin Waterhouse, 1786–1836 (inclusive).


16th Century

Riva di San Nazarro, Gianfrancesco. De peste libri tres. Avignon: Imp[re]ssum fuit p[re]sens opus in ciuitate Auenioni per solertem impressorem magistrum Johanem de channey, anno domini 1522 die 12 Septembus.

17th Century

Bologna (Italy). By the King, a Proclamation Concerning the Prorogation of the Parliament (forthcoming). London: Printed by John Bill and Christopher Barker, 1665.
Strauss, Gottfried, 1641–1706. De jure arcendi ob metum pestis…praeside…Godofredo Strauss…; publico exmini submittit Carolus Godofr. Vollmarus. Wittenbergae: Literis Viduae Brüningianis, 1683.
The Shutting Up Infected Houses as It Is Practised in England Soberly Debated. London: s.n., Printed in the year 1665.

18th Century

Chalmers, Lionel, ca. 1715–1777. An Account of the Weather and Diseases of South-Carolina. London: Printed for Edward and Charles Dilly, 1776.
Frank, Johann Peter, 1745–1821. System einer Vollständigen Medicinischen Polizey. Wien: Gedruckt bey J.T. Edlen von Trattnern, 1786–1790.
Grainger, James. An Essay on the More Common West-India Diseases: And the Remedies Which That Country Itself Produces, to Which Are Added, Some Hints on the Management, &c. of Negroes. London: Printed for T. Becket and P.A. De Hondt, 1764.
Howard, John, 1726–1790. An Account of the Principal Lazarettos in Europe: With Various Papers Relative to the Plague, Together with Further Observations on Some Foreign Prisons and Hospitals, and Additional Remarks on the Present State of Those in Great Britain and Ireland. The second edition, with additions. London: Printed for J. Johnson, C. Dilly, and T. Cadell, 1791.
Savoy (Duchy). Magistrat de Santé. Manifeste pour se Garantir du Mal Contagieux. A Chambery: Jacques Gorrin, imprimeur du Roy, 1740.


Baker, Thomas, b. 1819. The Laws Relating to Public Health: Sanitary, Medical, Protective: Including the Legislation to the End of the Last Session of Parliament. London: W. Maxwell, H. Sweet and Stevens, Sons & Haynes; Dublin: Hodges, Smith, & Co., 1865.
Great Britain. Poor Law Commissioners. Edwin Chadwick, Secretary. Report to Her Majesty’s Principal Secretary of State for the Home Department, from the Poor Law Commissioners on an Inquiry into the Sanitary Condition of the Labouring Population of Great Britain. London: Printed by W. Clowes and Sons, for H.M.S.O., 1842.
Maclean, Charles, fl. 1788–1824. Remarks on the British Quarantine Laws: And the So–Called Sanitary Laws of the Continental Nations of Europe, Especially Those of Spain. London: 1823.
New York Sanitary and Chemical Compost Manufacturing Company. The New York Sanitary and Chemical Compost Manufacturing Company: Organized 1864 ... For the Purpose of Cleansing Cities, Towns, and Villages in the United States, By the Use of Smith’s Patent Street-Sweeping Machines and Other Mechanical Appliances, the Manufacture and Sale of Chemical Compounds and Manures, Manufactured from the Offal and Refuse of Cities, the Introduction of Portable Water Closets in Public Buildings, Offices, Factories, and Work–Shops. New York: Published for gratuitous distribution, 1865.
Nightingale, Florence. How People May Live and Not Die in India. London: Emily Faithful, 1863.
Tardieu, Ambroise. Dictionnaire d’Hygiène Publique et de Salubrité. Paris: J.B. Baillière; Londres; New York: H. Baillière; Madrid: Bailly-Baillière, 1852–1854.


Blackwell, Elizabeth. Why Hygienic Congresses Fail: Lessons Taught by the International Congress of 1891. London; New York: G. Bell, 1892.
Farr, William, 1807–1883. Vital Statistics: A Memorial Volume of Selections from the Reports and Writings of William Farr. Edited for the Sanitary Institute of Great Britain by Noel A. Humphreys. London: The Sanitary Institute, 1885.
France. Commission d’études des Odeurs de Paris. Rapport Préliminaire sur les Causes des émanations Odorantes de Paris et de la Banlieue. Par A. Le Roy des Barres. Paris: Impr. et Libr. centrales des chemins de fer, Impr. Chaix, 1896.
Virchow, Rudolf Ludwig Karl. Gesammelte Abhandlungen aus dem Gebiete der öffentlichen Medicin und der Seuchenlehre. Berlin: A. Hirschwald, 1879.
Waring, George E. The Sanitary Drainage of Houses and Towns. New York: Hurd and Houghton; Cambridge: Riverside Press, 1876.


International Sanitary Conference of the American Republics (3rd: 1907: Mexico City, Mexico). Actas de la tercera Conferencia Sanitaria Internacional de las Repúblicas Americanas: Celebrada en la Ciudad de México del 2 al 7 de diciembre de 1907. Washington, D.C.: Oficina Internacional de las Repúblicas Americanas, 1908.
Sanitary Progress: Charts from the Prudential Insurance Company of America. New York: Statistician’s Dept., Prudential Insurance Co. of America, ca. 1920.
Save the Babies!: Rules to be Observed in the Care and Management of Infants During the Summer. Commonwealth of Pennsylvania, Department of Health. Harrisburg, Pa.: Dept. of Health, ca. 1915.
Rubinow, I. M. Health Insurance in Relation to Public Health. Pittsburgh, Pa.: Standard Sanitary M’frs’g Co., 1901.
Standard Sanitary Manufacturing Company. Modern Bath Rooms and Appliances: A Few Suggestions About Plumbing Valuable to Home Builders or Those About to Remodel Their Present Dwellings. Pittsburgh, Pa.: Standard Sanitary M’frs’g Co., 1901.


The following sources were used in writing this page.

Baldwin, Peter. Contagion and the State in Europe, 1830–1930. Cambridge, UK: Cambridge University Press, 1999.
Barnes, David S. The Great Stink of Paris and the Nineteenth–Century Struggle Against Filth and Germs. Baltimore: Johns Hopkins University Press, c2006.
Delaporte, Francois. Disease and Civilization: The Cholera in Paris, 1832. Arthur Goldhammer, trans. Cambridge, MA and London: MIT Press 1986.
Farmer, Paul. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press, 2003.
Harrison, Mark. Public Health in British India: Anglo-Indian Preventive Medicine 1859–1914. Cambridge: Cambridge University Press, 1994.
Jones, David S. Rationalizing Epidemics: Meanings and Uses of American Indian Mortality Since 1600. Cambridge, Mass.: Harvard University Press, 2004.
Latour, Bruno. The Pasteurization of France. Translated by Alan Sheridan and John Law. Cambridge, Mass.: Harvard University Press, 1988.
McKeown, Thomas. The Role of Medicine: Dream, Mirage, or Nemesis? Princeton, N.J.: Princeton University Press, 1979.
Rosen, George. A History of Public Health. Expanded edition. New York: MD Publications Inc., 1958. Baltimore: Johns Hopkins University Press, 1993.
Rosen, George. From Medical Police to Social Medicine: Essays on the History of Health Care. Expanded edition. New York: MD Publications Inc., 1958. Baltimore: Johns Hopkins University Press, 1993.
Rosenberg, Charles E. The Cholera Years: The United States in 1832, 1849, and 1866. Chicago: Chicago University Press, 1962, 1987.
Sigerist, Henry. Civilization and Disease. Ithaca, NY: Cornell University Press, 1943.
Tomes, Nancy. The Gospel of Germs: Men, Women and the Microbe in American Life. New York: Science History Publications, 1974.

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