Several weeks ago news headlines carried stories of a spattering of plague cases in China. To those who follow infectious disease, it was not surprising as parts of Asia is considered the home of plague and cases occur there with regularity. But despite these facts, media headlines invoked the Black Death. The Black Death, which occurred over 500 years ago, was a calamitous outbreak of plague that likely killed one-third of Europe’s population.
The news stories about these latest cases almost universally left out the context of the Black Death — no supportive care, no antibiotics, and malnutrition. They also did not mention that though person-to-person spread of plague involving the lungs — pneumonic — is possible, it is rare (and the cases reported were bubonic which should prompt little in the way of special measures).
While this was all happening, i was in the middle of a new book on the topic of plague entitled Black Death at The Golden Gate: The Race to Save America from the Bubonic Plague. This book, published in 2019, by David Randall tells the story of the turn-of-the-century outbreak of bubonic plague in San Francisco. This subject has been told before in books but Randall’s approach, to me, appeared fresh and full of details that I hadn’t quite recalled from prior reading on the subject.
In brief outline, the story of plague in San Francisco is one that is familiar to anyone who knows the history of infectious disease: a cycle of denial, overreaction, and bureaucratic interference. The backdrop of the events that occurred in San Francisco occurred in the midst of a power struggle between the US Surgeon General Walter Wyman and rising public health luminary Joseph Kinyoun who was exiled to the Angel Island quarantine station. At the time, plague had just raged in Hawaii leading to the literal burning of Honolulu’s Chinatown — an ominous development that Kinyoun did not want to occur in San Francisco
Plague first appeared in San Francisco as a single case in Chinatown prompting a draconian quarantine of the entire region and then, when tests were not fully completed, a reversal and then another quarantine. Randall also details the baffling stories of how plague deaths were hidden from authorities (which including propping dead bodies up to make them look alive). The book details the bureaucratic machinations that Kinyoun faced — including interference from President McKinley and the California governor (Gage) — and ultimately how he was replaced.
In the end, plague established itself in the US after public health measures failed to contain it and the book illustrates how failing to heed the warnings of public health authorities can prove disastrous. I think these themes are timeless and have been repeated countless times in outbreaks small and large from HIV, to hepatitis A, to SARS, to Ebola. I was struck by the lone brilliance of those like Kinyoun who were, instead of being rewarded, were punished for their foresight.
Randall also weaves in a great deal of the history of California, San Francisco, and the Chinese Six Companies into the narrative. He also highlights some of the anti-Chinese immigrant sentiment that permeated area even prior to the outbreak including mayoral candidates campaigning to keep California “white” and threats of violence against those that employed Chinese immigrants.
I highly recommend this book as a great introduction to the history of plague in the modern era but even more so as a great case study of how public health and infectious disease authorities face not only the microbe but often a hostile public and government leadership that must also be navigated with equal precaution.