THE BARBARY PLAGUE
The Black Death in Victorian San Francisco
By Marilyn Chase
Random House. 276 pp. $25.95
On a March afternoon in 1900, police in San Francisco were alerted to the mysterious death in the city's Chinatown quarter of a man named Wong Chut King, 41 years old: "The corpse bore no gross signs of foul play, no bullet holes or knife wounds, but the man had died of a violent disease." A police surgeon was called onto the case, and then a city health officer and a city bacteriologist. Together they performed a postmortem. No firm conclusion was immediately reached, but the evidence strongly suggested a case of bubonic plague, "the most famous scourge in history."
Plague it indeed was. Wong's death was the first of what eventually rose to "an official count of 121 sick and 113 dead" in 1900 and then, when the plague returned for nearly a year beginning in May 1907, another 160 sick and 77 dead. In both outbreaks, the plague was confined largely (but by no means entirely) to Chinatown: "Given the suspicion by many white doctors that the community had hidden some of its sick and the dead, the true total would never be known."
Confronted with those statistics -- 281 sick and 190 dead over a period of eight years -- many readers are likely to wonder, as this one did, if this was really an "epidemic." Marilyn Chase, who obviously (and understandably) has an investment in the dramatic elements of her story, insists that it was: "An epidemic is defined as any increase over the normal, baseline incidence of a disease. Before 1900, plague had no normal incidence in the United States. The San Francisco plague cases represented the first known outbreak in the continental United States. From that outbreak, plague established a foothold across the western states. Today, despite preventive vaccines and antibiotics, plague occurs in roughly a dozen people a year. Even forty cases of bubonic plague in any 21st-century American city would be considered an epidemic and an emergency. So 280 confirmed cases and 172 deaths certainly qualifies."
Apart from this statistical inconsistency -- 281 sick and 190 dead reported on one page of The Barbary Plague, 280 sick and 172 dead reported 20 pages later -- there remains the question of perspective. In 3rd-century Rome, the plague is believed to have killed as many as 5,000 people a day. The Black Death of the 14th century, racing through Europe and Asia between 1347 and 1352, killed somewhere around 25 million people. The Great Plague that struck London in 1665 killed 6,000 people a day, to a total of about 100,000. For that matter, the influenza epidemic of 1918 killed 20 million people around the world, 195,000 of them in the United States and 2,122 in San Francisco.
It scarcely is disrespectful toward those who died in San Francisco of the bubonic plague between 1900 and 1908 to point out that their numbers were exceedingly small. Doubtless during the same period far more people died in that city from influenza and other communicable diseases. Technically, the bubonic plague may have been an "epidemic," but technically and no more. As the word is commonly understood in ordinary discourse, this was a minor outbreak.
Yet it is an interesting and not unimportant story all the same, far less because of what it tells us about this particular disease than because of what it tells us about the human capacity for evasion and denial. Within the Chinese community of 20,000 to 30,000 people, most of them men working at menial labor and sending money to their families back home, there was widespread fear that, in a place where they already suffered from prejudice and discrimination, discovery of the plague would only make matters worse; so they circled the wagons, giving authorities as little information as possible, and often misinformation at that. Their fears were entirely legitimate. The city's immediate reaction to the Wong case and the others that soon followed was to quarantine Chinatown, first with "a penetrable quarantine made of flimsy ropes" but then with barricades "hardened with wooden fence posts and barbed wire."
That the quarantine was racially motivated was obvious: The zone "zigzagged to exempt white institutions, including the redbrick steeple of St. Mary's Church at California and Dupont Streets." The result was that "Chinatown churned in helpless frustration as the normal ebb and flow of business between whites and Asians was interrupted." Eventually Chinese leaders challenged the quarantine as "an act of racial bias, not public health" and were upheld in court, but the incident did nothing to improve cooperation among the Chinese with health authorities, some of whom actually were trying to help them.
The San Francisco power structure was similarly determined to deny reality, both in government and in the city's most important private enterprises. A "wall of denial and deceit" was put in place, aided and abetted by state and local medical authorities. Medical representatives of the federal government -- first quarantine officer Joseph J. Kinyoun, then his successor, Rupert Blue -- fought a constant war against these authorities: "Refusal to yield bodies, false death certificates, patients coached to keep silent -- it was all part of the daily game of resistance played by the state doctors, and it had Governor Gage's fingerprints all over it." That was Henry Gage, a hack politician whose popularity was declining and who was terrified by the prospect of a nationwide trade embargo to prevent the spread of the plague, which people everywhere feared for ample reason:
"Its symptoms were violent: Rampant fever, crushing headache, overwhelming nausea, and profound weakness swept over a person who had been strong only hours before. Inflamed lymph glands struggled to contain the invading bacteria. Wherever they swelled, a painful red bubo erupted. Inky hemorrhages burst from small vessels, staining the skin with blue black tattoos -- the fearful 'tokens' of Black Death. The pulses galloped at first, then later dwindled to a thread dancing beneath the doctor's finger. Delirium and pain unhinged the mind and stirred the limbs in an agitated dance of death. Victims in their final agony plucked at the bedclothes, unable to bear the slightest touch on their swellings."
Eventually, thanks in large measure to Rupert Blue, a systematic attack on the plague was organized. It had been brought to the city by rats aboard ships from Asia, Hawaii and other places where the disease thrived; it was communicated by fleas that leaped from one dead rat to another and then to humans. Under Blue's leadership, the rat population was greatly reduced and Chinatown -- much of it ramshackle, fetid, a breeding ground for disease -- was cleaned up, though the earthquake and fire of 1906 scarcely helped matters. Chinese resistance gradually gave way to cooperation, with the result that the plague's toll on the city was far smaller than it might have been.
It is, then, more a story about human nature than about disease and medicine. Marilyn Chase tries hard to present it as a medical detective story with dire possibilities resting on the outcome, and since she knows her medicine well (she covers it for the Wall Street Journal) she has assembled a fair amount of evidence. But the most interesting and convincing aspects of her tale are those about fear, deceit and denial, and about the handful of purposeful people who managed to overcome these obstacles. *
Jonathan Yardley's e-mail address is email@example.com.