In September of 1909, San Francisco’s businessmen opened the latest issue of the Merchants’ Association Review, looking forward to reading stories about the city’s recovery in the years since April 18, 1906. The earthquake on that spring day flattened the city’s financial center and its working-class district, and then reduced them to cinders in a three-day firestorm.
Among the usual stories about post-quake progress was an article titled, “Tuberculosis Class Work in the San Francisco Polyclinic,” by Dr. Philip King Brown. Tales of illness in the years after 1906 were not uncommon. Disease always follows disaster, and in the weeks after the quake doctors scrambled to contain typhoid and bubonic plague; others, like Brown, also saw a rise in tuberculosis rates.
The Polyclinic was a free clinic for people who lived in the poorest district, later (and still today) called the Tenderloin, and was staffed mostly by volunteer physicians, including Brown. The patients in the TB class — whom Dr. Brown called “students” — learned that the best defense against contracting TB was to breathe fresh air, eat well, and get enough rest. He taught them to sleep with their windows open (a screened porch was even better), because TB lurked in closed spaces. Brown knew that his poorer patients might not always eat well, but anyone could open a window.
But after about a year of monitoring the people who came to the Polyclinic, Brown noticed something alarming. The women in his clinic contracted tuberculosis in far greater numbers than the men did. It didn’t take him long to figure out why, and he spelled it out in the Review: “The opportunities that are open to women are distinctly against them, not only being conducive to the acquiring of tuberculosis, but offering a minimum of opportunity for recovery under the present conditions … when they acquire a tubercular lung infection they are very apt to go steadily downhill.”1
Why did Brown publish this in a magazine aimed at the city’s commercial men? Fundraising was one reason, because the Polyclinic ran on donations. But Brown also wanted businessmen to know that a crisis was looming among the women who sewed the clothes the men wore, and who waited on their wives at the city’s chandelier-filled department stores.
Philip King Brown was worried about San Francisco’s working women. He came by this concern naturally, because he spent his life surrounded by women.
A family tradition
Born in 1869 in Napa, California, he was a middle child sandwiched between two sisters. In 1872, his mother Charlotte Blake Brown left her husband and three children to train as a doctor at the Woman’s Medical College of Pennsylvania. When she returned to Napa in 1874, Charlotte packed everyone up and moved them to San Francisco to start her practice.
As he grew, Philip Brown watched his mother live and breathe her profession, treating poor women who called at her home office, and the ones who called her away from the dinner table to deliver their children or bind up their broken bones. When it came time to choose a career, Philip Brown chose medicine.
With a Harvard MD in hand in 1893, he settled in San Francisco and took on hospital appointments and volunteer work, in addition to his own practice. In 1900, he married Helen Hillyer, the surrogate daughter of Phoebe Apperson Hearst, arts patron, champion of young women, philanthropist, and long-suffering mother of publisher William Randolph Hearst. Helen worked for suffrage and pacifism as World War I loomed, and gave birth to four children between 1901 and 1911.
The Browns owned a home on the European-style thoroughfare of Van Ness Avenue in San Francisco, but lost it to the 1906 fires. Philip also lost his office and medical equipment, but unlike many others, he and Helen had adequate financial resources to rebuild their lives.
Thousands of little unavoidable cares
As he worked at the Polyclinic in the years after the earthquake, Brown watched laboring women walk through its doors in the first stages of TB. He knew their workplaces were part of the problem. “As laundry-workers, dressmakers, clerks, factory-workers, inner-office workers, they are where the most unsanitary conditions in business life are found.”2 The same was true of their homes: working-class women often lived in multi-family residences with poor ventilation and plumbing. Some doctors called tuberculosis “a house disease” because it was so ubiquitous in these neighborhoods.3
Men worked outdoors to rebuild the city, getting the fresh air necessary to stay healthy. But the detritus they swept up settled into the dark corners where women labored, and there it stayed. Tied to sewing machines and typewriters, women were forced to stay inside for long hours, breathing in what no one should ever have in their lungs. Brown also thought about the “thousands of little unavoidable cares”4 the women had to deal with when the work day was over: cleaning, cooking, caring for children.
Brown knew his Polyclinic class wasn’t enough to keep the city’s working women healthy. What’s more, although San Francisco General Hospital had a collection of wards for the tuberculous, there weren’t enough doctors or beds for everyone. So he turned to his mother’s life and career for inspiration. In 1875, irritated that San Francisco didn’t have a hospital focused on treating mothers and their children, Dr. Charlotte Brown had co-founded the Pacific Dispensary for Women and Children, which later became Children’s Hospital.
Now, Philip Brown’s female patients needed a sanatorium. So, in the spirit of his maverick mother, Brown decided to build his own.
The Rest Cure
Until streptomycin was discovered in the 1940s, the only way to conquer TB was the rest cure, perfected by Dr. Edward Trudeau in Saranac Lake, New York, in the 1880s. He built the first true tuberculosis sanatorium, where patients stayed in bed in the open air or in screened wards, ate fattening food, and endured medical interventions such as pneumothorax, which artificially collapsed the lung. This allowed macrophages, a type of scar tissue, to grow about the tubercle bacilli, walling them off until a patient was no longer actively ill or contagious. It wasn’t a real cure, though. Macrophages could break open if your health broke down and the disease could become active again, sending you back to the sanatorium, or worse. Faced with horrific public health statistics, doctors and municipalities opened sanatoria all over the United States, about four hundred of them by 1910. Barely a handful were for women only but, in September 1911, Dr. Brown opened the newest one, a place he called Arequipa.
In early 1910, Brown started talking to his wealthy friends, fellow doctors, the wives of his wealthy friends, and his wife’s mentor, Phoebe Hearst. He needed money to build his sanatorium and he had no trouble getting the financing he needed. He also needed a plot of land and architectural plans for the sanatorium building, and within a year he had both. Real estate magnate Henry Bothin donated forty acres west of the village of Fairfax, north of San Francisco in Marin County. John Bakewell, famed local architect and friend of Phoebe Hearst, drew and donated the plans for a graceful, brown-shingled building, open on all sides to wide balconies, with windows of wire screen, not glass.
On September 9, 1911, Arequipa’s opening ceremony began, with five patients in residence. The unusual name came from the Quechua language, and meant “here, rest,” a word Brown learned from a neighbor who captained the ship Arequipa in Central American waters. What better name to call a TB sanatorium?
Dr. Philip Brown was Arequipa’s medical director until his death in 1940. His son Cabot succeeded him, keeping the sanatorium open until 1957. Drug therapies replaced the rest cure during the 1950s and sanatoria all over the United States quietly closed.
In 1960, the Girl Scouts acquired the property and the sanatorium building. Hundreds of little girls spent spooky overnights in the old structure until it was damaged by heavy rains and torn down in 1984. Girls still come to Camp Arequipa today, and leaders tell them about Dr. Brown and his legacy.
Corena Green, a reporter for Marin’s Daily Independent Journal newspaper, wrote the best epitaph for Arequipa in 1960, as the Girl Scouts prepared to make it theirs:
- Philip King Brown, “Tuberculosis Class Work in the San Francisco Polyclinic,” Merchants’ Association Review 14 (September 1909): 5–6. Return to text.
- Brown, “Tuberculosis Class Work,” 6. Return to text.
- Paul Groth, Living Downtown: The History of Residential Hotels in the United States (Berkeley: University of California Press, 1994), 205–206. Return to text.
- National Tuberculosis Association, Transactions of the Fourteenth Annual Meeting, June 6–8, 1918 (New York: National Tuberculosis Association, 1919), 436. Return to text.
- San Rafael Daily Independent Journal, July 11, 1960. Return to text.