SEWERS AND SCAPEGOATS - SPATIAL METAPHORS OF SMALLPOX IN 19TH-CENTURYSAN-FRANCISCO

Medical geography is slowly including more social and cultural theory in its analysis of health issues. Yet there is still room for theoreti cal growth in the discipline, in areas such as historical inquiry, met aphoric landscapes of disease, and the role of disease and its interpr etations in the production of place. With the example of four smallpox epidemics in nineteenth century San Francisco, application of these c oncepts is illustrated. Each successive epidemic in San Francisco brou ght stronger association of the disease with Chinatown, until an almos t complete metonymy of place and disease had occurred by the last deca des of the century. The articulation of biased medical theory onto a l andscape of xenophobia engendered this metaphorical transformation of Chinatown into a pustule of contagion threatening to infect the rest o f the urban body. A less metaphoric mapping of smallpox focused on the sewer. According to 19th-century miasmatic theories of epidemiology, sewers were the most dangerous urban topographical feature. In an incr easingly class-stratified city, they undercut attempts of the upper cl asses to escape disease by carrying smallpox-causing miasmas across cl ass and ethnic boundaries. A reinvigorated sanitation movement was the result. Both reactions to smallpox epidemics had significant influenc e in shaping San Francisco's landscape, real and symbolic.