Plague in San Francisco

PLAGUE IN SAN FRANCISCO

Two Outbreaks

Bubonic plague is a disease caused by the Yersinia pestis bacillus and is most often transmitted from rats to humans by infected fleas; symptoms include virulent fever and swollen lymph nodes. Known since biblical times, bubonic plague has swept through various regions of the world during the last fifteen hundred years. At least four widespread outbreaks—pandemics—have occurred as well as many local outbreaks, or epidemics. In the first decade of this century, the disease struck San Francisco twice. The second of these two epidemics suggested how effective a coordinated public health campaign could be, but the first showed how political meddling could lead to deadly results.

Death in Chinatown

On 6 March 1900 the body of a Chinese worker was discovered in the Globe Hotel basement. The dead man was one of more than eighteen thousand Chinese and almost two thousand Japanese who lived in a fourteen-block area of San Francisco. At this time the city was California's major city, and the area known as Chinatown was among its important tourist attractions. When the assistant city physician, Dr. Frank P. Wilson, performed an autopsy, he discovered symptoms that suggested plague. He notified the city health officer, Dr. A. P. O'Brien, and bacteriologist Dr. Wilfred H. Kellogg. These men confirmed the discovery and contacted Dr. Joseph J. Kinyoun, the chief quarantine officer of the U.S. Marine Hospital Service in San Francisco. After O'Brien recommended a quarantine of twelve blocks in Chinatown, the head of the city's board of health, Dr. John M. Williamson, ordered police to surround the area, and a search for more cases began. When the Marine Hospital Service's surgeon general, Walter Wyman, was informed of the situation, he recommended further aggressive measures, including inoculation of all Chinese with a plague vaccine. In 1900 only twenty-two cases of the plague were documented, though many other victims were never found because of deliberate efforts to hide them.

TYPHOID MARY

Mary Mallon was a thirty-one-year-old immigrant from northern Ireland who spent much of the first decade of the twentieth century cooking for wealthy families in New York. Mary had eight jobs in seven years, and typhoid fever—a disease that results in the inflammation of the small intestine, fever, coughing, abdominal pain, and diarrhea—followed in her path. Although never sick herself, she spread the disease in the households where she worked and beyond. At least fifty-three cases and three deaths can be attributed directly to Mary Mallon, but she may have been responsible for fourteen hundred cases in Ithaca, New York, in 1903. Epidemics of the disease at the time could cause thousands of cases and many deaths.

Mary Mallon was the first carrier of typhoid to be identified. Public health officials persuaded her to enter Riverside Hospital in the Bronx section of New York City in 1907, and she became infamous in the newspapers of the day. She was released in 1910 and promised to stop working as a cook but quickly disappeared. Around 1914 she was located again and quarantined for life in the hospital. Officials built a cottage for her on the grounds, and she died there on 11 November 1938.

Source:

Richard Gordon, "Typhoid Mary: Death on a Plate," Great Medical Disasters (New York: Stein & Day, 1983), pp. 77-80.

Political Reaction

On 19 February 1904 the last case of plague in the city's first outbreak of the decade was confirmed. During the four years of the endemic a pitched battle over control of the disease took place between medical officials on one side and most public officials, businessmen, and news outlets on the other. San Francisco's mayor James Phelan and his successor E. E. Schmitz, governor Henry Gage, and American and Chinese business leaders all denied the existence of the disease. Gage declared that plague "did not nor ever did exist in California." One city newspaper mocked Kinyoun's efforts in verse. Because of public pressure, the initial quarantine did not last three days. One newspaper, the Examiner, did accept the plague reports. Because that paper was part of a chain owned by William Randolph Hearst, the news quickly spread around the country.

Federal Response

To break this impasse, Surgeon General Wyman sent a prominent surgeon, Joseph H. White, to assess the situation. White recommended the appointment of a blueribbon panel, and Drs. Simon Flexner, L. F. Barker, and Frederick G. Novy were chosen as members of this "Commission for the Investigation of the Existence or Non-Existence of Plague in San Francisco." This committee confirmed the existence of plague in the city in March 1901. Their report was largely ignored; Governor Gage even appointed his own committee—loaded with prominent newsmen and business leaders—which failed to find any evidence of plague. Antiplague efforts were left to San Francisco health officials and the Marine Hospital Service.

The Tide Turns

Despite one hundred confirmed cases by the end of 1902, Governor Gage denied that the plague was a threat in his final legislative message as governor in January 1903. Fortunately, he was soon succeeded by George C. Pardee, a physician who declared himself ready to cooperate with local and federal health authorities. Early in 1903 an emergency conference convened in Washington, D.C., to discuss the plague problem. Calls were made for a complete quarantine of California. Such talk finally convinced the business community that further action was needed, and an extensive eradication effort was finally mounted. Decaying buildings in Chinatown were either demolished or repaired to eliminate the rat infestation. By early 1904 the plague had subsided.

Second Outbreak

In April 1906 an earthquake devastated San Francisco and provided excellent conditions for another plague epidemic. A little more than a year later two city physicians diagnosed several cases of the disease. This time the mistakes of the earlier outbreak were not repeated. Under the auspices of the Citizens' Health Committee local, state, and federal health and political officials together with business leaders immediately recognized the presence of the disease and began aggressive measures to fight it. An extraordinary voluntary education and eradication campaign aided the official efforts. By the time a final report was issued in March 1909, this second effort was a credit to the city and a model for action in the face of public health emergencies. Two more outbreaks in 1919 and 1924 received similar responses.

Sources:

Loren George Lipson, "Plague in San Francisco in 1900," Annals of Internal Medicine, 77 (August 1972): 303-310;

Guenter B. Risse, "'A Long Pull, a Strong Pull, and All Together': San Francisco and Bubonic Plague, 1907-1908," Bulletin of the History of Medicine, 66 (Summer 1992): 260-286.