The Pandemic Century

by The Pandemic Century- One Hundred Years of Panic, Hysteria

  Thankfully, the 1900 outbreak had been brought under control with just 121 cases and 113 deaths, and when plague revisited San Francisco in 1907 politicians and health officials no longer tried to pretend it was a fiction, moving swiftly to contain the disease by launching an extensive rat extermination campaign. Like other bacteriologists and officials who had been “blooded” by America’s first experience of plague, Kellogg remained a keen student of the disease, and when in the winter of 1910 reports reached California of an outbreak of pneumonic plague in Manchuria, he followed news of the spreading outbreak keenly. Most likely sparked by tarbagans, a species of Mongolian and Siberian marmot valued for their fur, the epidemic appears to have begun at Manchouli, near the Chinese-Siberian border, in October 1910 before spreading via the trans-Manchurian railway to Harbin and other towns along the way. The principal culprits were inexperienced Chinese hunters who had been attracted to Manchuria by the high prices for pelts and did not take as much care as Manchurian trappers when handling sick tarbagans. As the Manchurian winter closed in and the hunters headed back to China, they mingled with returning agricultural workers and “coolies,” crowding into packed railway carriages and inns. Soon, hospitals were overrun with patients, and by February 1911 some 50,000 people had died. Many of the bodies were cremated or dynamited in plague pits. According to Wu Lien-Teh, a Cambridge-educated Chinese plague expert who made a detailed study of the epidemic, reports of buboes were entirely absent, but pneumonic symptoms were ubiquitous. Working with the American physician and tropical medicine specialist Richard Strong, Wu performed twenty-five autopsies and used bacteriological techniques to confirm the presence of Y. pestis, subsequently presenting the evidence at the International Plague Conference called by the Chinese in Mukden in 1911.

  At this time, most experts subscribed to the idea that plague was a rat-borne disease, most likely communicated by fleas, so the idea that the bacillus could be spread in droplet form directly to humans from tarbagans and marmots was controversial. But when the Chinese and Japanese authorities made a close examination of rats—some 50,000 were rounded up—they could not find any evidence of infection, and support for the theory grew. Some experts suspected the Manchurian strains were more virulent than those associated with previous bubonic outbreaks in India and elsewhere; others that the tarbagan-derived bacilli were pneumotrophic, meaning they had an affinity for the lungs. This theory received a boost when Strong, who headed the Biological Laboratory in Manila (part of the Philippine Bureau of Science) and led the American delegation to the conference, demonstrated that plague bacilli could be cultured from agar plates on which patients had been allowed to breathe, and that tarbagans could also be infected with pneumonic plague if exposed to the organism in droplet form.

  Another compelling theory concerned the weather. In Manchuria the average temperature during the three months of the epidemic had been –30°C, whereas in India, where plague had raged on and off since 1896 and had been largely bubonic, the average temperature had been 30° C. Hypothesizing that the failure of pneumonic plague to spread in India had been due to the higher average temperatures there, Oscar Teague and M. A. Barber, two bacteriologists attached to the Philippine Bureau of Science, decided to perform a series of evaporation experiments with Y. pestis and other infectious bacteria. These showed that sprayed plague droplets disappeared very quickly from the atmosphere in conditions of low humidity, whereas the converse was the case in conditions of high humidity. “Such an atmosphere is, under ordinary circumstances, of common occurrence in very cold climates, whereas it is extremely rare in warm ones,” they wrote. “Hence, since the droplets of sputum persist longer, the plague bacilli remain alive longer in the air, and there is a greater tendency for the disease to spread in cold climates than in warm ones.”

  Not everyone was persuaded by this argument, however, or convinced that climate had been the decisive factor. Though impressed by the cold weather in Harbin in 1910, Wu did not think it had played a major part in the Manchurian outbreak, pointing out that there was “ample evidence” to show that pneumonic outbreaks also occurred in regions with hot climates, such as Egypt and West Africa. Instead, Wu believed that the decisive factor had been the overcrowding and the proximity to infectious patients, pointing out that “most infections occurred indoors, specially at night-time, when the coolies returned to their warm but crowded shelters.” Nor did he accept another theory according to which the cold weather had resulted in the wide dispersion of frozen particles of plague-infected sputum. “If infection occurred in the open, it certainly was a direct one from patient to patient, and did not result from inhalation of frozen particles of sputum,” he stated.

  Weighing the circumstances of the Oakland outbreak, Kellogg concluded that the health department had been fortunate that the outbreak had occurred in August, as the warm weather and low humidity meant that “conditions were not favorable for the transfer of infected droplets.” The result was that “the drying and consequent death of the bacillus was so rapid that the ordinary measures of prophylaxis . . . sufficed to check the progress of the infection.” Had the weather been cooler or the atmospheric water deficit lower, then things might have been different, he acknowledged, but that had not been and was unlikely to be the case in California. While San Francisco and Los Angeles needed to be on their guard against further cases of bubonic plague sparked by stray squirrels, he concluded, it was cities in the East that should be most concerned about the pneumonic form of the disease. All it would take, he observed, was for someone to be infected by a squirrel and, while incubating the disease, journey to “some eastern state in winter time and [develop] an infection such as that of Di Bortoli.” He concluded that while the persistence of sylvatic reservoirs of plague in California ground squirrels consituted a permanent risk of the bubonic form of the disease, the pneumonic form was “probably not a serious menace on the Pacific coast, owing to climatic conditions.”

  THE IDENTIFICATION OF Y. pestis in Horace Gutiérrez’s sputum and the symptoms of severe pneumonia with bloody expectorations and cyanosis should have been a wake-up call that the improbable had happened and that pneumonic plague was at large in the Mexican quarter, even as Los Angeles broiled in a late fall heat wave. But that is not what happened. Instead, fearing the political and economic repercussions, not to mention the panic that might attend an official announcement that the Black Death had arrived in the city of the future, health officials prevaricated. On being shown the slide packed with rod-shaped bacteria, the city’s health commissioner, Dr. Luther Powers, denied the evidence in front of his eyes, telling Maner the slide had been poorly prepared and that he needed to rerun the tests. Nevertheless, he took the precaution of sending quarantine officers to the Macy Street District, telling them there had been a “return of [Spanish] flu” in a virulent form in the Mexican quarter. By now, Maria Samarano, Guadalupe’s 80-year-old grandmother—the woman whom Bogen had examined at Carmelita Street—had been admitted to County General, and on November 1 she died, becoming the fourth victim of the outbreak. But still no one dared utter the “p” word in public. However, the evening before, the hospital’s superintendent had sent a telegram to state and federal officials asking where he might obtain plague serum and vaccine. One of the telegrams was intercepted by Benjamin Brown, the PHS’s senior surgeon in Los Angeles. Not sure that he could trust what he was reading, Brown called the hospital to inquire if there were plague patients on its wards, then wired the Surgeon General, Hugh S. Cumming, to alert him to the gravity of the situation. Encoding his telegram for secrecy, he dictated: “Eighteen cases ekkil [pneumonic plague]. Three suspects. Ten begos [deaths]. Ethos [situation bad]. Recommend federal aid.” In response, Cumming ordered James Perry, a senior surgeon stationed in San Francisco, to proceed to Los Angeles and make discreet inquiries, but by now quarantine officers were roping off the eight city blocks that encompassed the death house at Clara Street and newspapermen were asking questions.

  Infe
ctious diseases have long been objects of rumor and panic. When the identity of the pathogen is unknown or uncertain, and information about the outbreak is veiled in secrecy, these rumors—and the fears that attend them—can quickly spiral out of control. The first into print was the Los Angeles Times, posting a report on November 1 that nine mourners who had attended the wake at 742 Clara Street had died of a “strange malady” resembling pneumonia. Listing the victims by name, perhaps so its readers would have no doubt that, for the moment, this was a Hispanic rather than an Anglo-Saxon problem, the paper went on to report that eight more people were confined to the hospital’s isolation ward and that some of these were also “expected to die.” The paper also revealed that the health authorities had “isolated a germ” but, like the Herald Examiner and other Los Angeles papers, the Times avoided mentioning the dreaded word plague. Instead, the paper stated that there would be no official announcement until bacteriological studies had been concluded, and that for the moment patients had been given “the technical diagnosis of Spanish influenza.” Incredibly, it was this or a similar coded report in another California paper that seems to have alerted Kellogg’s colleague, Dr. William Dickie, the secretary of the State Board of Health, that something was amiss in the Mexican quarter. Dickie immediately sent a telegram to Dr. Elmer Pascoe, Los Angeles’s acting health officer, asking him to “Kindly wire immediately cause of death of Lucena Samarano [sic].” Pascoe, who had only just taken up the city’s top health post following the sudden death of the previous occupant from a heart attack, kept his answer brief and to the point, “Death L.S. caused by Bacillus pestis.”

  By now the quarantine had been extended to Belvedere Gardens, confining some 4,000 people within the plague zone, and the police and fire department had strict instructions not to let anyone in or out of the roped-off area. In addition, guards had been posted at the front and back of homes that were known to contain or that had formerly contained plague victims. Public gatherings were also prohibited, and parents were instructed to keep their children out of school and away from movie houses. Even Pacific Electric trolley cars, which continued to run along Macy Street, were banned from letting riders board or alight at stops near the quarantined area.

  This was Los Angeles’s shark-in-the-water moment. The sight of armed guards barring entry to the Mexican quarter was the equivalent of posting signs on the beach that it was no longer safe to enter the sea. But rather than admitting the truth, city and health authorities, with the backing of local newspaper editors, sought to maintain the fiction that, as the Los Angeles Times put it, the outbreak was merely a “malignant form of pneumonia.” This infuriated El Heraldo de Mexico, the Spanish language newspaper, which railed against “the hermetic silence in which authorities have locked themselves.” But it was a lone voice and no other paper in Los Angeles dared mention plague. Outside Los Angeles, however, it was a different story. “21 Victims of ‘Black Death’ in California,” declared the Associated Press on November 1. “Pneumonic Plague is Feared after 13 die in Los Angeles,” announced the Washington Post on November 2. “Pneumonic Plague takes seven more victims,” reported the New York Times on November 3.

  The contrasting treatment of the outbreak in America’s metropolitan dailies perhaps says more about the rivalries between East and West Coast business elites, and commercial concerns about the plague’s economic impacts, than it does about the competence of Los Angeles health officials. Faced with the publicity nightmare of a disease from the Dark Ages appearing in twentieth-century Los Angeles, it is little wonder that the first instinct of the city’s civic leaders and their press allies was to obfuscate. As George Young, the managing editor of the Herald Examiner, informed the Board of Directors of the Los Angeles Chamber of Commerce, Hearst newspapers “would print nothing we didn’t think was in the interests of the city.” At stake was not merely the viability of Los Angeles’s tourism industry and future real estate sales, but the ambition to make the Port of Los Angeles at San Pedro the largest commercial harbor in the United States. Should federal health officials in Washington suspect plague was anywhere near the port, the surgeon general would have no choice but to close the harbor and impose a strict maritime quarantine. Once a quarantine had been instituted it would continue for at least ten days and could only be lifted when the authorities were sure the city was free of plague and there was no danger of the disease being reintroduced to wharfside areas by rats and other rodents. But by that point, of course, the damage to the city’s reputation would have been done.

  By contrast, for the New York newspapers there was nothing like plague to boost circulation, especially when the outbreak lay a safe 3,000 miles to the west. Besides, for years Los Angeles had boasted of its superior climate and quality of life, bombarding easterners with postcards adorned with sun-kissed orange groves and preternaturally happy couples. Never mind if reporting the truth fostered panic: it was worth it just to puncture the booster hubris and wipe the smirk off those sunny Californian faces.

  IN 1924 there was no treatment or cure for pneumonic plague. The best that physicians could offer were stimulants such as caffeine and digitalis, or depressants, such as morphine. In theory, vaccines containing killed bacteria or convalescent serums containing antibodies from patients who had survived infection with plague might have made a difference, but only if convalescents with immunity to the disease could be found in time and the serums administered early enough in the infection to make a difference to the course of the disease. In the absence of such measures, 90 percent of infections were fatal.

  For those who had attended Luciana Samarano’s wake, had boarded in her rooming house, or who had helped care for one of her sick or dying relatives, it was almost certainly too late. But for those who had not yet been exposed to infectious sputum or blood from the Samaranos’ extended family, there was one measure that was certain to break the chain of infections: quarantine and the rapid isolation of the sick. These measures had eventually halted the outbreak in Harbin in 1911, and they had also stemmed the outbreak in Oakland in 1919. Even without an official diagnosis of plague, physicians at County General were sufficiently wary of the infection and the alarming symptoms of cyanosis to place patients in an isolation ward and wear masks and rubber gloves when approaching their beds. However, the decision to quarantine Macy Street and Belvedere Gardens appears to have had little to do with infection control and everything to do with racism and prejudice.

  Reconstructing the precise sequence of events is difficult given the incomplete documentation and the lack of transparency by the Los Angeles newspapers and Mayor George Cryer. But what is certain is that only Walter Dickie, the secretary of the State Board of Health, had the legal authority to order a quarantine of the Mexican quarter and he did not learn about the outbreak until November 1, by which time, of course, the area had already been roped off. Instead, it seems that the decision was made by the county health chief, J. L. Pomeroy, acting on his own initiative. Though Pomeroy was a qualified doctor, his decision appears to have had less to do with his knowledge of plague than his experience of previous quarantines and his low regard for Mexicans. By the 1920s ethnic quarantines, spurred by fears of smallpox and typhus being introduced by migrants from across the border, had become a routine measure in Los Angeles and other southern Californian towns. According to Pomeroy, special guard details were “the only effective way of quarantining Mexicans,” and he ordered his men to institute the quarantine by stealth so as not to spread alarm. To this end, Pomeroy conscripted seventy-five police officers and positioned his men discreetly at the boundaries of Macy Street and Carmelita Street in Belvedere Gardens. To avoid “a general stampede,” he instructed the guards to wait until after midnight when they were certain all residents had returned home. It was only then that ropes were strung around the zone and the “quarantine was [made] absolute.” The measures, which were in force for two weeks, would eventually extend to five urban districts in which Hispanics were known to reside. How
ever, only two of these, Macy Street and Belvedere, had verifiable cases of plague. As Deverell puts it, “the others had only verified cases of ethnicity. In other words, Mexicans lived there.”

  Though judged by today’s standards Pomeroy’s methods were discriminatory, they appear to have been extremely effective. With the exception of an ambulance driver who ferried one of the patients to the hospital, all the casualties, bar one, came from within the quarantine zone and could be traced to the Samarano clan or to mourners who had been present at one of the wakes. Indeed, Pomeroy’s decision to impose a quarantine seems to have been prompted in part by the questioning of boarders who shared the house at 343 Carmelita Street with Guadalupe’s elderly mother, Maria Samarano. This was the address that Bogen had visited two days earlier and where he had discovered Maria and Guadalupe’s brother, Victor, lying deathly ill. By the time Pomeroy arrived at Carmelita Street, Victor was dead of suspected “meningitis.” However, on quizzing the other boarders and learning that Victor had recently attended his father’s funeral, Pomeroy immediately posted armed guards at the front and back of the house. Next, he discovered that one of Luciana Samarano’s cousins had died at another house in Belvedere Gardens and that his wife was also ill with what was presumed to be the same disease. This was the flag that appears to have convinced Pomeroy to draw a wider line around Macy District and extend the quarantine to Belvedere Gardens, even though it lay across the city line in Los Angeles County.