The San Francisco plague of 1900–1904 was an epidemic of bubonic plague centered on San Francisco's Chinatown. It was the first plague epidemic in the continental United States. The epidemic was recognized by medical authorities in March 1900, but its existence was denied for more than two years by California's Republican governor Henry Gage. His denial was based on business reasons, to protect the reputations of San Francisco and California and to prevent the loss of revenue due to quarantine. The failure to act quickly may have allowed the disease to establish itself among local animal populations.Echenberg 2007, p. 237 Federal authorities worked to prove that there was a major health problem, and they isolated the affected area; this undermined Gage's credibility, and he lost the governorship in the 1902 elections. The new governor, George Pardee, implemented public-health measures and the epidemic was stopped in 1904. There were 121 cases identified, resulting in 119 deaths.Echenberg 2007, p. 231
Much of urban San Francisco was destroyed by a fire in the 1906 San Francisco earthquake, including all of the Chinatown district. The process of rebuilding began immediately but took several years. While reconstruction was in full swing, a second plague epidemic hit San Francisco in May and August 1907 but it was not centered in Chinatown. Cases occurred randomly throughout the city, including cases identified across the bay in Oakland. San Francisco's politicians and press reacted very differently this time, wanting the problem to be solved speedily. Health authorities worked quickly to assess and eradicate the disease. Approximately $2 million was spent between 1907 and 1911 to kill as many rats as possible in the city in order to control one of the disease's vectors.
In June 1908, 160 more cases had been identified, including 78 deaths, a much lower mortality rate than 1900–1904. All of the infected people were European, and the California ground squirrel was identified as another vector of the disease. The initial denial of the 1900 infection may have allowed the pathogen to gain its first toehold in America, from which it spread sporadically to other states in the form of sylvatic plague (rural plague). However, it is possible that the ground squirrel infection predated 1900.
Background
The third pandemic of the plague started in 1855 in China and eventually killed about 15 million people, mainly in India. In 1894, the plague hit Hong Kong, a major trade port between China and the US.Echenberg 2007, p. 6 US officials were worried that others would get infections from cargo carried by ships that would cross the Pacific Ocean. For these reasons, all ships were rigorously inspected. At that time, however, it was not widely known that rats could carry plague, and that fleas on those rats could transmit the disease to humans.Echenberg 2007, p. 7 Ships arriving in US ports were declared clean after inspection of the passengers showed no signs of disease. Health officials conducted no tests on rats or fleas.Echenberg 2007, p. 11 Despite important advances in the 1890s in the fight against bubonic plague, many of the world's doctors did not immediately change their ineffective and outdated methods.Kitasato Shibasaburō first described the plague bacteria in Hong Kong in 1894. Simultaneously but independently, Alexandre Yersin described and named the plague bacterium, and proved the rat to be a major vector in plague. Masanori Ogata and Paul-Louis Simond, acting independently, proved the flea was a critical link in 1897. The same year, Waldemar Haffkine developed a vaccine to inoculate humans against the disease. These advancements were discussed in 1897 at medical conferences, but many doctors continued with their previous and outdated methods of dealing with the disease.
In November 1898, the US Marine Hospital Service (MHS) chief surgeon, James M. Gassaway, felt obliged to refute rumors of plague in San Francisco. Supported by the city's health officer, Gassaway said that some Chinese residents had died of pneumonia or lung edema, and it was not bubonic plague.
In the newly formed US Territory of Hawaii, the city of Honolulu fell victim to the plague in December 1899. Residents of Honolulu were reporting cases of fever and swollen lymph glands forming buboes, with severe internal organ damage – quickly leading to death. Not knowing precisely how to control the spread of the disease, city health officials decided to burn infected houses. On January 20, 1900, changing winds fanned the flames out of control, and nearly all of Chinatown burned——leaving 6,000 without homes.Chase 2003, p. 12
The extensive maritime operations of the port of San Francisco caused concern among medical men such as Joseph J. Kinyoun, the chief quarantine officer of the MHS in San Francisco, about the infection spreading to California. A Japanese ship, the S.S. Nippon Maru, arriving in San Francisco Bay in June 1899, had two plague deaths at sea, and there were two more cases of stowaways found dead in the bay, with postmortem cultures proving they had the plague. In New York in November 1899, the British ship J.W. Taylor brought three cases of plague from Brazil, but the cases were confined to the ship. The Japanese freighter S.S. Nanyo Maru arrived in Port Townsend, Washington, on January 30, 1900, with 3 deaths out of 17 cases of confirmed plague. All of these ships were quarantined; they are not known to have infected the general population. However, it is possible that plague escaped some unknown ship by way of fleas or rats, later to infect US residents.
In this atmosphere of grave danger, January 1900, Kinyoun ordered all ships coming to San Francisco from China, Japan, Australia and Hawaii to fly yellow flags to warn of possible plague on board.Chase 2003, p. 18 Many entrepreneurs and sailing men felt that this was bad for business, and unfair to ships that were free of plague. City promoters were confident that plague could not take hold, and they were unhappy with what they saw as Kinyoun's high-handed abuse of authority. On February 4, 1900, the Sunday magazine supplement of the San Francisco Examiner carried an article titled "Why San Francisco Is Plague-Proof".Chase 2003, p. 223 Certain American experts held the mistaken belief that a rice-based diet left Asians with a lower resistance to plague, and that a diet of meat kept Europeans free from this disease.Kraut 1995, p. 85
Infection
In January 1900, the four-masted steamship S.S. Australia laid anchor in the Port of San Francisco.Chase 2003, p. 13 The ship sailed between Honolulu and San Francisco regularly, and its passengers and crew were declared clean. Cargo from Honolulu, unloaded at a dock near the outfall of Chinatown's sewers, may have allowed rats carrying the plague to leave the ship and transmit the infection. However, it is difficult to trace the infection to a single vessel.Markel 2005, p. 224 Wherever it came from, the disease was soon established in the cramped Chinese ghetto neighborhood; a sudden increase in dead rats was observed as local rats became infected.Chase 2003, p. 28
Rumors of the plague's presence abounded in the city, quickly gaining the notice of authorities from MHS stationed on Angel Island in San Francisco Bay, including Chief Kinyoun.
A Chinese American named Chick Gin, Wing Chung Ging or Wong Chut King became the first official plague victim in California.Kalisch 1972, p. 113Echenberg 2007, p. 214Chase 2003, p. 17 The 41-year-old man, born in China and a San Francisco resident for 16 years, was a bachelor living in the basement of the Globe Hotel in Chinatown, at the intersection of the streets now called Grant and Jackson.Chase 2003, p. 210 The Globe Hotel was built in 1857, with the appearance of an Italian palazzo. However, by the mid-1870s it was a squalid tenement crowded with Chinese residents. Just outside, Jackson Street was the Chinese red-light district, where unmarried men could visit "hundred-men's-wives".
On February 7, 1900, Wong Chut King, the owner of a lumber yard, fell sick with what the Chinese doctors thought was typhus or gonorrhea, the latter a sexually transmitted disease common to Chinatown's residents at that time. After failed medications and no relief for his illness, he died in his bed after suffering for four weeks. In the morning, the body was taken to a Chinese undertaker, where it was examined by San Francisco police surgeon Frank P. Wilson on March 6, 1900. Wilson called for A.P. O'Brien, a city health department officer, after finding suspiciously swollen lymph glands. Wilson and O'Brien then summoned Wilfred H. Kellogg, San Francisco's city bacteriologist, and the three men performed an autopsy as night closed. Looking through his microscope, Kellogg thought he saw plague bacilli.
Late at night, Kellogg ran the suspicious samples of lymph fluid to Angel Island to be tested on animals in Kinyoun's better-equipped laboratory – an operation that would take at least four days. Meanwhile, Wilson and O'Brien called upon the city's Board of Health and insisted that Chinatown be quarantined immediately.Shah 2001, p. 120
When dawn came on March 7, 1900, Chinatown was circled by rope and surrounded by policemen preventing egress or access to anyone but Whites. The 12-block area was bordered by four streets: Broadway, Kearney, California and Stockton. Approximately 25,000–35,000 residents were unable to leave.Kraut 1995, pp. 84–85 Markel 2005, pp. 63–64 Chinese Consul General Ho Yow felt that the quarantine was likely based on false assumptions and that it was entirely unfair to Chinese people and would seek an injunction to lift the quarantine.Markel 2005, p. 65 San Francisco mayor James D. Phelan was in favor of keeping the Chinese-speaking residents separated from the Anglo-Americans – claiming that Chinese Americans were unclean, filthy, and "a constant menace to the public health."
Nevertheless, the Board of Health lifted the quarantine on March 9 after it had been in force for only 2½ days. O'Brien said, by way of explanation, that "the general clamor had become too great to ignore". The animals tested in Kinyoun's lab seemed to be in normal conditions after the first 48 hours of being exposed to the possible plague-causing agents. The lack of early response cast doubt on the theory that plague was the cause of Wong Chut King's death.
On March 11, Kinyoun's lab presented its results. Two guinea pigs and one rat died after being exposed to samples from the first victim, proving the plague was indeed in Chinatown. Without restoring the quarantine, the Board of Health inspected every building in Chinatown, and labored to disinfect the neighborhood. Property was taken and burned if it was suspected of harboring filth. Using physical violence, policemen enforced compliance with the Board of Health's directives. Angry and worried Chinese communities reacted by hiding those that were sick.Markel 2005, p. 66
On March 13, another lab animal, a monkey that was exposed to the plague, died. All of the dead animals tested positive for the plague bacteria. U.S. Surgeon General Walter Wyman informed the San Francisco doctors at the end of March 1900 that his laboratory confirmed the fact that fleas can carry the plague and transmit it to a new host.
Denial and suppression by governor