In producing a localized history, the question is raised of how unique San Francisco as a western city was in its response to a disease that plagued the east coast and elsewhere well before San Francisco even existed. Did the rhetoric of salubrity make San Francisco different in its responses to consumption and sanitation problems? This question will be addressed at greater length, but the answer in brief is both yes and no. In many ways San Francisco was not different from any other US or western European city, because it was eventually characterized by the same conditions of crowding and squalor that fostered the spread of tuberculosis in all urban areas. Whether in Paris, London, Boston or New York, sewers and other sanitation problems were largely the focus of public health authorities during the middle and last decades of the century, and in this San Francisco was no exception. A difference seems to show, however, in the degree to which the structural problems of the city, and more specifically of poverty, were effectively addressed. Many cities, London, Paris, Manchester and New York among them, focused attention by the mid-nineteenth century on the growing problems of poverty, and implemented measures such as slum clearance and housing reform to reduce its impact. San Francisco showed few serious efforts in this direction, but it is difficult to say whether this was because of a struggle with its image, or because it had simply not had as long a history of urbanism and its concomitant problems as had east coast and European cities.