Book Review Series: Contagious Divides

This is the second iteration of a book review series for Immigration Medicine & Immigration Policy-specific reads. Join me in my quest to dive deeper into the world of Immigration Health literature!

In chronological fashion through Contagious Divides, Nayan Shah works through the establishment of San Francisco’s Chinatown, the Public Health department and various predominantly-white communities’ efforts to force the Chinese community to assimilate to the white American standard. He also explores Chinatown’s struggles with San Francisco’s first bubonic plague in 1900 and medical quarantine measures on Angel Island, and the eventual successful integration of the Chinese into mainstream culture.

Background

Nayan Shah is a Professor of American Studies and Ethnicity and History at the University of Southern California. Throughout this book, he presents a summation of how the Chinese communities in San Francisco transitioned from menace to society to model immigrant group. As you’ll soon surmise, it is at times a painfully academic book geared toward scholars, but certainly has some very real medical applications and poignant intersections of immigration policy and medicine/health, which is what this blog is all about.

Struggles

Shah starts off detailing how Chinese immigrants were perceived as foreign and strange – even pestilent – and the majority white American population forced communities into a specific sector of San Francisco to cordon off their influence. “Scientific” embarkments of journalists and government officials in San Francisco further characterized the spaces of Chinatown as dark, cramped, unsanitary, and thoroughly immoral. Prostitution and opium dens were seen as the prevailing Chinatown norms at the time, inextricably linking race and public health.

As the SF public health government body grew, racial difference as a source of medical and physiologic difference was perpetuated. Chinatown was identified as a dangerous space and further grooved in separations between the Chinese community and the rest of San Francisco.

Chinese residents were not allowed at public hospitals, and even when groups of Chinese merchants banded together to build their own hospital, they were refused by officials due to its proposed location outside of Chinatown- there were concerns from the surrounding communities about ongoing Chinese community containment.

The number of Chinese male immigrants far exceeded female immigrants, and the burgeoning Chinese bachelor society was viewed as incredibly odd. Many women and children living together in a house without a male at the helm, and this confused community surveyors, as they did not consider this a family when contrasting it with the nuclear middle-class white ideal. Prostitution was prosecuted, and this further isolated single women occasionally engaging in prostitution by making them more vulnerable, requiring them to relocate to specific alleys dedicated to such activities, such that they were easily recognizable and were not able to engage in other forms of work.

Shah details physician Mary Sawtelle's incredibly racist rhetoric and untoward concern about female Chinese prostitutes spreading syphilis to young white American boys and men and, subsequently, into white American homes. Placing the blame on the female participants alone and hyperbolizing the issue of syphilis as a Chinese-specific disease, she aimed to expel Chinese immigrants from San Francisco altogether.

Contingent Acceptance

Shah then details the first bubonic plague outbreak in 1900, wherein Chinatown was forcibly quarantined and the bubonic plague was inextricably linked to Chinese bodies and culture in the public news rhetoric. An attempted forced vaccination of Chinatown residents with the nascent bubonic plague vaccine came up against fierce disapproval from Chinatown residents. Shortly after this quarantine, a cultural shift began to occur - in part due to the 1906 earthquake and the rebuilding process that physically incorporated Chinatown into city sanitation and sewer services, and in part due to a second bubonic plague situated outside of Chinatown that demonstrated that the plague was, in fact, not culturally or racially specific.

Not that this transition was an easy or linear journey, however! There was still significant pushback from white labor party groups, who feared the cheap labor offered by Chinese immigrants and coupled Chinese-produced goods with contamination. The San Francisco Public Health Service also forced many Asian immigrants into barracks at Angel Island to quarantine due to concerns that they were vectors of disease - subjecting them to environmental conditions that they were concerned produced the disease state in the first place - filthy, crowded and rat-infested locales.

However, the acquiescence to these quarantines for the supposed protection of non-Chinese or non-Asian SF citizens and to ensure fitness and health caused them to be more accepted into mainstream American society. They subsequently participated in public schools, the YMCA/TYCA, and well-baby and child-health clinics - creating a sharp divide between Chinese immigrants who were seen as acquiescent and willing to assimilate into mainstream American culture, and those who adhered to Chinese medicine and cultural norms, the latter of whom were considered backward and persistently outsiders.

Overall Impression

3 out of 5 stars

While Contagious Divides is at times painfully academic, the examples of how the San Francisco Chinatown community butted heads with the Public Health Service and struggled to find their place in a new country is compelling.

This is an interesting deep dive into one community's struggle for acceptance, and their struggles and ultimate contingent folding into mainstream American culture- depending on their willingness to assimilate- shares common threads with many other immigrant communities today.

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Feel free to leave a comment or share your experience below if you have had the chance to read Nayan Shah's work!