Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health
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The Barbary Plague: The Black Death in Victorian San Francisco
Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA 94720-7360
By Marilyn Chase
ISBN 0-375-75708-2, Random House, New York, New York (Telephone: 1-800-733-3000, Fax: 212-940-7381, E-mail: atrandompublicity{at}randomhouse.com, Website: http://www.randomhouse.com), 2004, 304 pp., $13.95 (paperback)
The Barbary Plague: The Black Death in Victorian San Francisco by Marilyn Chase (1) belongs to that genre of books that provide a broad social, cultural, and historical context for epidemiologic issues. Good examples are Randy Shilts’ And the Band Played On, the story of the genesis of the acquired immunodeficiency syndrome (AIDS) epidemic in San Francisco (2), and Jane S. Smith’s Patenting the Sun: Polio and the Salk Vaccine, the behind-the-scenes story of the development of the inactivated poliovirus vaccine (3). The Barbary Plague chronicles the bubonic plague epidemics of 1900–1904 and 1907–1908 in San Francisco. It is the story of a deadly epidemic, the application of new science, political chicanery, blatant racism, judicial involvement, personal heroism, indefatigable perseverance, and the triumph of good over evil. Four men dominate the saga: Joseph J. Kinyoun, first director of the Hygienic Laboratory (forerunner of the National Institutes of Health), who was inexplicably transferred to the quarantine station on Angel Island in San Francisco Bay in 1900; Walter Wyman, Surgeon General of the Marine Hospital Service; Henry T. Gage, Governor of California; and Rupert Blue, who was destined to succeed Walter Wyman as Surgeon General.
Marilyn Chase’s lucid narrative provides a dramatic description of the dynamic city of San Francisco at the turn of the 20th century. Its ethnic diversity, social stratification, and physical beauty are thoroughly described to provide the setting in which the first plague death occurred in a Chinese workman on March 6, 1900. When a recently arrived expert, Marine Hospital Service bacteriologist Joseph J. Kinyoun (he had trained in the laboratories of Pasteur and Koch), confirmed the diagnosis and identified several additional cases among Chinatown residents, Chase documents an unprecedented chain of events. Residents of Chinatown, threatened by a quarantine, hid their plague-sickened and dead compatriots; newspapers, business leaders, and Governor Gage denied the existence of plague in San Francisco and vilified Kinyoun for, as they put it, fabricating the existence of the disease. When a quarantine of Chinatown was imposed, a resident brought a suit in federal court alleging that there was no plague in Chinatown and, therefore, the quarantine was illegal. The judge ruled in favor of the claimant, not because he believed the testimony regarding the nonexistence of the plague but, rather, because the quarantine treated the residents of Chinatown differently from the residents of the rest of the city, thus violating the 14th Amendment guarantee of equal protection. When the epidemic continued and worsened in 1901 and 1902 and Governor Gage’s attacks on Kinyoun became more strident, Surgeon General Wyman sent a "blue ribbon" commission to San Francisco to resolve the impasse over the recognition of the epidemic. When the commission’s report, confirming Kinyoun’s findings, was submitted to Governor Gage and Surgeon General Wyman, an agreement was struck to conceal the findings and to reassign Kinyoun. In return, the Governor then agreed to allow the Marine Hospital Service to supervise an intensified control program. However, implementation continued to be desultory. It was only when pressure from a number of state health departments threatened a quarantine of California and a new governor was elected to replace Gage that an intensified control program was implemented under the direction of Kinyoun’s successor, Rupert Blue. By the end of 1904, the epidemic seemed to be controlled. No cases had occurred in 6 months. Blue was reassigned early in 1905. A total of 121 cases and 113 deaths had been recorded during the course of the epidemic. However, San Francisco was to be granted only a brief reprieve.
On April 18, 1906, the city was devastated by a great earthquake followed by a destructive fire. Chase documents the disaster graphically. Hundreds of thousands were made homeless. Hastily organized refugee camps struggled to provide a minimum of life support necessities. Amidst this chaos, it was no surprise that rats thrived, and with them the plague returned. The first case was recorded in May 1907. Rupert Blue returned to lead the control efforts, but this time the effort was supported by the public and by government officials. A "Citizens’ Health Committee," made up of the city’s most prominent leaders and appointed by the mayor, backed Blue’s strategy: By inspection, identify rat refuges and destroy them; remodel housing and commercial properties to eliminate potential rat refuges; trap, poison, and slaughter rats as well as autopsy them to determine the prevalence of plague-infected animals; and identify and isolate human cases of plague. Blue was indefatigable and, by the end of 1909, plague had disappeared from San Francisco. Yet, a sinister consequence of the epidemic had been discovered: Plague had spread widely in the ground squirrel population of northern California, where it remains endemic today!
Chase’s characterization of Kinyoun is mixed. While recognizing his scientific expertise and accomplishments before, during, and after the epidemic and the resistance from the Governor, the press, and the Chinese community, she portrays him as arrogant, insensitive, and discriminatory in his efforts to promote an effective control effort. At the same time, however, Chase points out that Kinyoun was harassed by his superior, Surgeon General Wyman, who had summarily reassigned him from an important position in which he had been eminently successful—namely, Director of the Hygienic Laboratory—to a remote and undesirable post at the quarantine station on Angel Island; who had failed to support him when attacked by Governor Gage; and who had reassigned him to other undesirable postings to remove him from the plague control effort. From Angel Island, Kinyoun went to the Detroit quarantine station for 2 months and then, when ordered to Hong Kong, he resigned from the Service. Kinyoun ended his career as head of the District of Columbia Public Health Laboratory, where he employed as summer interns medical students from Georgetown University Medical School. One of these, Thomas Parran, later became one of the most influential surgeon generals of the Public Health Service. Parran is quoted as saying of his relationship with Kinyoun, "I consider him to have been the first teacher I ever had and one who really determined my choice of public health as a career" (4, p. 170). Apparently, Kinyoun’s dedication to the field was undeterred by his treatment by Surgeon General Wyman.
Chase’s characterization of Blue is quite different. She portrays him as an indefatigable worker skilled in public relations and possessed of a vision of how public health could alleviate suffering and improve the lives of the people. Her treatment of Blue is substantially more comprehensive than her treatment of Kinyoun, no doubt because of the existence of a substantial archive of relevant documents. Blue succeeded Wyman as Surgeon General of the renamed US Public Health and Marine Hospital Service in 1911 and led the agency during the "war years," a period of rapid expansion in function and personnel.
Chase does not provide us with characterizations of Surgeon General Wyman and Governor Gage. We can only surmise from her narrative that Wyman was an "autocrat" and Gage a political "hack." Nevertheless, during the 20 years that Wyman served as Surgeon General (1891–1911), the Marine Hospital Service was transformed from strictly clinical functions to a broad-ranging public health organization. Gage served one term as Governor. He was elected by the Southern Pacific political machine, served the interests of the railroad, opposed reforms, and presided over a corrupt and venal administration.
The Barbary Plague shows, once again, the complex interplay of social, political, environmental, biologic, and personal factors that determine the nature and course of an epidemic. Curiously, many of the forces that influenced the plague epidemics of 1900–1904 and 1907–1908 were again in play in San Francisco for the currently ongoing human immunodeficiency virus (HIV)/AIDS epidemic. For example, the resistance of the gay community to the closing of bathhouses, demonstrated loci of contagion, and the reluctance of the Health Department to take action to close them are reminiscent of the resistance of the residents of Chinatown to acknowledging the presence of plague among them and the desultory implementation of control measures during the early years of the plague epidemics.
The book is impeccably annotated. Chase drew principally on private manuscript collections, public archives, and newspaper files as her primary sources. References are grouped for each chapter at the end of the narrative, thus avoiding the clutter of footnotes but providing easily accessible notes and bibliography. The notes and bibliography will be a valuable resource for scholars and anyone interested in this bizarre epidemic.
Written by a professional journalist, the book is eminently readable. For students of epidemiology (and aren’t we all), The Barbary Plague is both instructional and inspirational.
REFERENCES
REFERENCES
- Chase M. The Barbary plague: the black death in Victorian San Francisco. New York, NY: Random House, Inc, 2004.
- Shilts R. And the band played on. New York, NY: St. Martin’s Press, 1987.
- Smith JS. Patenting the sun: polio and the Salk vaccine. New York, NY: William Morrow and Company, Inc, 1990.
- Harden VA. Inventing the NIH: federal biomedical research policy, 1887–1937. Baltimore, MD: The Johns Hopkins University Press, 1986.
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