An eye-opening discussion of the ways disease shapes urban society

Disease may not discriminate, but it helps those who do. In this fascinating book, Susan Craddock examines the role of disease and health policy in the construction of race, gender, and class, and in urban development in nineteenth- and twentieth-century San Francisco. An absorbing look at the role of disease and health policy in the construction of race, gender, and class in urban development during nineteenth- and twentieth-century San Francisco. Susan Craddock considers tuberculosis, plague, smallpox, and syphilis as diseases whose devastations were derived in part from their use as political tools and disciplinary mechanisms

    In 1859 a Hungarian obstetrician named Ignaz Semmelweis, reflecting on his years as resident in the Vienna maternity clinic, wrote a graphic account of his attempt to diagnose and eliminate the then epidemic scourge of childbed fever.  The resulting Etiology triggered an immediate and international squall of protest from Semmelweis’s colleagues; today it is recognized as a pioneering classic of medical history.  Now, for the first time in many years, Codell Carter makes that classic available to the English-speaking reader in this vivid translation of the 1861 original, augmented by footnotes and an explanatory introduction.  For students and scholars of medical history and philosophy, obstetrics and women’s studies, the accessibility of this moving and revolutionary work, important both as an historical document and as a groundbreaking precursor of modern medical theory, is long overdue.
    Semmelweis’s exposure to the childbed fever was concurrent with his appointment to the Vienna maternity hospital in 1846.  Like many similar hospitals and clinics in the major cities of nineteenth-century Europe and America, where death rates from the illness sometimes climbed as high as 40 percent of admitted patients, the Viennese wards were ravaged by the fever.  Intensely troubled by the tragic and baffling loss of so many young mothers, Semmelweis sought answers.  The Etiology was testimony to his success.  Based on overwhelming personal evidence, it constituted a classic description of a disease, its causes, and its prevention.  It also allowed a necessary response to the obstetrician’s already vocal, rabid, and perhaps predictable critics.  For Semmelweis’s central thesis was a startling one - the fever, he correctly surmised, was caused not by epidemic or endemic influences but by unsterilized and thus often contaminated hands of the attending physicians themselves.
    Carter’s translation of this radical work, judiciously abridged and extensively footnoted, captures all the drama and impassioned conviction of the original.  Complementing this translation is a lucid introduction that places Semmelweis’s Etiology in historical perspective and clarifies its contemporary value.  That value, Carter argues, is considerable.  Important as a model of clinical analysis and as a chronicle of early nineteenth-century obstetrical practices, the Etiology is also a revolutionary polemic in its innovative doctrine of antisepsis and in its unique etiological explanation of disease.  As such its recognition and reclamation allows a crucial understanding, one that clarifies the roots and theory of modern medicine and ultimately redeems and important, resolute, pathfinder.

The overall picture of changing birthing practices is complex and sometimes tinged with ironies. As the introduction says, "These Samoan nurses and midwives did not immediately attempt to mediate new and old ways of birthing after the colonial leadership of their profession left. They themselves became cultural agents for change as they continued the role of 'colonizing' their own birth tradition and taught the fa'atosaga [Samoan for midwife] Western techniques, at the same time trying to provide a professional midwife for all women. Paradoxically they often chose a social midwife for their own births and supported or at least condoned the social midwives close to them. . . . Kaisarina, while working as the leading professional midwife in the country, and working almost totally in hospital practice herself, simultaneously assisted her mother-in-law with her social practice of midwifery. Vipulo's story shows how a professional midwife preferred to have her mother, a social midwife, deliver her at home."

A particular objective of the authors is to encourage a reconception of maternity care in countries where professional services are rare and not available to all women. The book challenges common assumptions, still held in many postcolonial countries, that a simple migration of Western-style, hospital-focused care is necessarily always an achievable or desirable goal. It also demonstrates the considerable progress that one group has made in rethinking and developing a model of maternity care that works within their society and culture. As these midwives' stories suggest, solutions to some of the problems caused by gaps in the kinds of resources that Westerners take for granted can be found in partnerships and cultural wisdom that already exist in Samoa and, by extension, other developing countries.