relationship between rat and flea, Gage says the San Francisco outbreak could have killed many more if it weren’t for that odd quirk of anatomy in the flea’s gizzard. He is among those who believe that the 1894 plague pandemic killed millions in Asia partly because its carrier was the Oriental rat flea, with its spiny foregut. Dr. Gage believes San Francisco was spared a similar fate because most of the local fleas lacked the anatomy of a killer.
All the other ingredients for an epidemic of devastating mortality were in place: the same bubonic plague germ, a massive population of rats, and a populace numbed by racism, ignorance, greed, and protectionism. A mote inside a speck of an insect saved the Barbary Coast from the fate of Florence or London.
People might wonder if San Francisco had a milder strain of plague bacteria. But Gage says this is unlikely. The strain covering the western United States today, which emanated from 1900 San Francisco, is the same one that savaged Asia and spread around the globe during the pandemic of 1894. Even more powerful evidence of this shared strain is the fact that those who did contract plague in San Francisco died with breathtaking speed. The mortality of the first plague outbreak in Chinatown was 93 percent. In the second citywide outbreak in 1907, the mortality rate fell to under 50 percent, thanks to faster diagnosis, hospitalization, and treatment with Yersin’s antiserum. Such treatment, though primitive by today’s standards and lacking in curative antibiotic drugs, would have included fluids, fever medication, and nursing care. It may have helped save patients’ lives, or at least eased their deaths.
The decade of the Barbary plague, 1900–1909, was a transitional moment in history between Victorian and modern San Francisco. Many of its landmarks have been destroyed by earthquake or razed by subsequent development. The corner of Dupont (today’s Grant Avenue) and Jackson Street, the site of the Globe Hotel, where Wong Chut King died, is today occupied by a glass-fronted retail bank. Where the Japanese brothel once stood, small trading companies and clothing stores rub elbows with souvenir and herbalist shops. The Merchant Street laboratory was leveled by the 1906 earthquake, but the alley remains as a passage between Chinatown and the skyline-piercing tower of the Transamerica Pyramid. Portsmouth Square, once dotted with quarantine tents, is a park once more where children play and aged Chinese do their morning tai chi exercises.
The Victorian house at 401 Fillmore Street that was home to the plague lab and rattery is now gone, replaced by a bland stucco apartment. Lobos Square, where the plague attacked eighteen refugees in their earthquake shelters, is now a park called Moscone Playground, just a block from the marina and yacht harbor. But the century- old Merchants’ Exchange on California Street is intact; strollers can still walk inside the building where Rupert Blue rallied the citizens and transformed their apathy into activism.
Angel Island is now a state park. Nothing remains of Kinyoun’s 1900 quarantine station at Hospital Cove, now Ayala Cove. Immigrants’ detention barracks, opened in 1910, are now a museum where poems carved in Chinese characters on the walls give mute testimony to the pain of exclusion. The smell of disinfectant baths is today replaced by the scent of barbecue. Boats arrive to disgorge not waves of immigrants, but waves of picnickers who come for a day in the sun.
San Francisco’s epidemic response, though slow to arouse, served the city well almost a century later in 1981, when acquired immunodeficiency syndrome struck its homosexual community. In the early days of the AIDS epidemic, when denial or discrimination clouded the country’s vision, San Francisco was a model of swift and compassionate care. Today, as other epidemics strike, stricken countries must sometimes learn all over again that the politics of denial, commercial protectionism, and discrimination too often trump science and sound medical judgment. Mad cow disease, or bovine spongiform encephalopathy, a brain-wasting disorder, ravaged British cattle herds in the 1980s and 1990s. The human form of the disease, called variant Creutzfeld-Jakob disease, has so far lethally infected 125 people in the process. Might this tragedy have been avoided if government and industry has acted sooner? Denial, protectionism, and the search for scapegoats arise when epidemics strike. The politics of 1900 San Francisco, far from being an anomaly, simply forshadowed the dynamics of epidemics to come.
By now, a sophisticated public knows that germs don’t respect national boundaries. Yet ironically, when plague struck India in 1994, Americans eyed their international airports with terror. What if a person, sick with the highly contagious pneumonic form, had boarded a plane in Bombay or Delhi and landed in New York? Those who were the most afraid didn’t know plague was already deeply imbedded in the landscape of the American West. Borders that were porous a century ago are even less substantial today in an age of jet travel. Disease fighters at CDC have even less time to prepare than they had in the era of travel by steamship.
The eradication or control of many infectious diseases from smallpox to polio has led us, we’re often told, to a false sense of security. In September 2001, the arrival of anthrax spores in letters awakened the world to the reality that old diseases may return as tools of terror.
Erosion of the public health system left the country vulnerable, just as these diseases come out of retirement. Whether they are in the hands of domestic murderers, stateless terror cells, or large state-funded weapons programs, this threat requires the same preparedness for massive outbreaks as the country faced in centuries past.
In a haunting counterpoint to Blue’s struggle to subdue plague, several countries of the world have studied the germ as a candidate for biological weapons. As early as the fourteenth century, Tatar soldiers hurled plague- infected corpses over town walls in the present-day Crimea. In World War II, the Japanese refined germ warfare a bit, by raising infected rats and fleas in grain-filled bathtubs, and sifting the lethal insects over unsuspecting people in China. After decades of official denial, the Tokyo District Court in August 2002 acknowledged that the attacks took place, in a reversal reported by the world’s press.
During the Cold War, the United States explored making plague weapons, but was thwarted when the germ cultures lost virulence over time in the test tube.8 The project was abandoned, but not without exacting a price. In 1959, a young chemist who was analyzing plague at the U.S. Army’s laboratory in Fort Detrick, Maryland, was swept by chills and fever, vomiting, and a bloody cough. Despite having taken the vaccine and booster shots, he was saved only by massive doses of streptomycin. Narrowly surviving pneumonic plague, he suffered liver damage from his ordeal. Three years later, a veteran microbiologist at Fort Detrick’s British counterpart in Porton Down, England, was less fortunate. While studying
Both the United States and England abandoned their biological weapons research decades ago, and signed the Biological Weapons Convention, banning germ warfare in 1975. However, the former Soviet Union continued its massive, covert bioweapons program until 1992. While debriefing defectors, Westerners learned for the first time of Soviet ambitions to create the deadliest of plague weapons—along with anthrax, smallpox, and other scourges. Unlike Japan’s primitive rain of fleas on Manchuria during World War II, the Russians improved the hardiness of the plague bacterium, which it code-named “L1.” At its weapons plant in the city of Kirov, it maintained a quota of twenty tons of pure plague in its arsenal.10
Defectors such as Kenneth Alibek worry that the specter of plague as a doomsday weapon has secretly survived the public dismantling of the Soviet bioweapons industry. However, the threat has also given new impetus to ongoing scientific initiatives to analyze and understand the genetic blueprint of
For plague doctors, the days before Paul-Louis Simond’s flea discovery were like the days before Walter Reed discovered the role of mosquitoes in yellow fever.
“We were fighting in the dark,” Blue said.12
Through his tenure as surgeon general and afterward, Rupert Blue revisited his years as a plague fighter. And sometimes they revisited him. Ragtag men would appear at his Washington office without an appointment, startling his secretary.
“Just dropped by to visit with Dr. Blue for a minute,” announced the veterans of Blue’s old rat brigades.13
Ushered into Blue’s office, they saw a figure thicker about the waist, his boxer’s chest now avalanched into a paunch that strained his vest and watch fob. Gray at the temples, he’d kept his trademark mustache. Blue welcomed the frayed visitors to reminisce a moment about the days of the quarter bounty and the rainbow
