19th Century Medical Self-Help
Historical Essay by Dr. Joan B. Trauner
Dr. Trauner is a research specialist at the University of California, San Francisco, Medical Center in the History of Health Science Department. 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. 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.” 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.”
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.” 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. Some Chinese of the merchant class did seek treatment from Caucasian physicians, usually for surgical care not available from Chinese practitioners. 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.”
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.
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. 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.
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.
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. (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.” 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. This project, too, must have been shelved because no further trace of this hospital can be found.
Tung Wah Dispensary, opened in 1900 by the Chinese Six Companies at 828 Sacramento St.
Shortly thereafter bubonic plague was discovered in Chinatown; public officials suddenly were faced with the fact that no health facilities existed in Chinatown for the care of plague victims. As early as May, 1900, the surgeon general of the Marine Hospital Service, Dr. Walter Wyman, suggested that one of the more “substantial” buildings in the area should be converted into a pest hospital. The War Department, on the other hand, preferred to see the Chinese quarantined on Angel Island. Neither plan went into effect, and in April, 1901, the San Francisco Board of Supervisors appropriated funds for the erection of a hospital in Chinatown. The city auditor immediately declared that the appropriation was illegal, and accordingly, the hospital was never constructed.
About the time that plague was discovered in Chinatown, the Chinese Six Companies realized that it was imperative for the Chinese community to organize its own health care system. The result was the Tung Wah Dispensary which opened in 1900 at 828 Sacramento Street. The dispensary, which employed both Western trained physicians and Chinese herbalists, was funded entirely by the Chinese Six Companies, and this dispensary was to be the forerunner of the present-day Chinese Hospital which opened its doors in April, 1925.
In 1900, in addition to financing the dispensary, the Chinese Six Companies instituted legal action to prevent local, state, and national officials from enforcing discriminatory measures aimed at the Chinese. In court, their attorneys won the right for non-licensed Chinese physicians to attend autopsies conducted under the jurisdiction of the San Francisco Board of Health. Similarly, their lawyers forced the courts to end the quarantine of Chinatown as ordered by the Board of Health. In May, 1900, when the U.S. Marine Hospital Service imposed a ban on interstate travel by Asiatics, the secretary of the Chinese Six Companies obtained a restraining order from the U.S. circuit court, arguing that such a ban was unfair class legislation.
Public health officials were infuriated by the legal tactics of the Chinese Six Companies. Dr. J. J. Kinyoun, federal quarantine officer for San Francisco, expressed his indignation in the following statement:
The various injunctions which have been entertained by both state and federal courts … have all conspired to convince the Chinese Six Companies that they in nowise consider the Chinamen amenable to observe or comply with the health laws of the city, state, or United States. The attitude assumed by this powerful corporation forms a good excuse for the individual Chinaman to follow suit and set at naught and defiance any or all rules and regulations which are considered necessary for the sanitary protection of the citizens of this state and country.
Although the Chinese were extremely hostile to the official anti-plague measures, this lack of cooperation stemmed in part from their unfamiliarity with public health procedures. When quarantine of Chinatown was first instituted, the Chinese attempted to prevent door-to-door inspection by locking up their homes and shops. When health officials attempted to vaccinate the Chinese with Haffkine prophylactic serum, riots broke out in Chinatown. Finally, when health officials came into the area to search for victims of the plague, the sick were reportedly hidden in the cellars and “subterranean passages” of Chinatown. Health officials despaired, neither understanding nor sympathizing with the motives of the Chinese. In the words of J. J. Kinyoun: “We never can expect to accomplish in our dealings with this race what we intend to do.” Accordingly, in 1905 after the first episode of the plague had ended, public health officials retreated from Chinatown, unofficially delegating the Chinese Six Companies with the responsibility of caring for the health needs of the Chinese community.
In the years to come, the overcrowded living conditions in Chinatown were to result in a high incidence of tuberculosis. For instance, the average yearly death rate from tuberculosis for the years 1912-1914 was 622 deaths per 100,000 as compared to a citywide average of 174. In 1929, after the introduction of tuberculin testing of cattle and pasteurization of milk, the Chinese mortality rate was 276 deaths per 100,000 as compared to a citywide average of 8 3. Yet, until 1933 no public health facilities existed within Chinatown for the diagnosis or treatment of tuberculosis. One 1915 health report noted the absence of clinics in the Chinatown area and stated as follows: “The Six Companies is probably in a better position than any other group to cooperate with the Board of Health in instituting curative and preventative measures among their own people.” In other words, the city had adopted a “hands off” policy with regards to health care among the Chinese. Not until March 1933, when the Chinese Health Center was established in the nurses’ room at the Commodore Stockton School, would the city attempt to cope even half-heartedly with the tuberculosis problem in Chinatown.
Today, the outright discrimination against the Chinese has ceased. Nevertheless, a continuing phenomenon is the reluctance of many Chinese–particularly among the aged or non-English speaking immigrant groups–to seek health services outside of the Chinatown area. Thus, while members of the Chinese community routinely seek medical care in hospitals, offices, and clinics throughout San Francisco, Chinatown itself continues to present a unique situation for the organization of health services. In one sense, the Chinese ceased being medical scapegoats by 1905; after that date, advances in medical science made obsolete the nineteenth-century policy of condemning the Chinese as “carriers of alien disease.” However, the failure of the City and County of San Francisco to provide health services within Chinatown was to have a more enduring effect. As late as 1967, the only outpatient facility furnishing acute medical services to the Chinese indigent in Health District IV (Chinatown-North Beach) was the Telegraph Hill Neighborhood Clinic, located in North Beach and funded in part by the United Crusade and by the San Francisco Department of Public Health. The city facility–the Northeast Health Center–was housed during this period in the basement of the Ping Yuen Housing complex; a tuberculosis clinic, a well-baby clinic, dental services, an immunization center, and a public health nursing service were all provided in 1200 square feet of converted laundry space. In other words, a paucity of medical services existed in Chinatown as late as the 1960′s; not until the 1970′s was the situation finally remedied.