by Black Death at the Golden Gate- The Race to Save America from the Bubonic Plague (retail) (epub)
On September 11, 1901, Wong told Blue that Ng Chan, a twenty-eight-year-old clerk, lay close to death in the basement of the Fook Lung grocery store at 821 Washington Street. Federal doctors who arrived at the building found fifteen other men living in the rank underground room, their small bunks partitioned by stacks of dirty boxes. Ng lay in a bed among them, overcome by a fever that topped 103 degrees. Doctors performed a quick examination of his body and discovered a swollen bubo on his right groin. Fearing plague, the men carried Ng to the nearby Tung Wah Dispensary, the closest thing to a hospital, and built a makeshift isolation ward while preparing to take a tissue sample that would confirm their suspicions.
That was as far as the doctors were able to get in treating a patient whom they believed carried a disease deadly enough to kill millions. The man’s friends arrived at the facility and physically blocked the doctors from getting close enough to conduct any further procedures. The secretary of the state Board of Health then burst into the room and declared that the man was merely suffering from a venereal disease and must be released at once. When Blue refused, the official announced that he was taking command of the dispensary under a recently passed state law that granted the state Board of Health the authority to lift any locally imposed quarantine. Blue denied him again, objecting that treating a sick man in an improvised hospital bed could in no way be construed as a quarantine.
While Blue bickered over jurisdiction, Ng’s friends formed a plan to sneak him out of the building to a ranch on the Sacramento River, where he could hide while his illness took its course. Wong picked up word of the plan from a janitor and alerted Blue. A police officer was posted at the man’s door to prevent an escape. Ng remained in the care of federal doctors for three weeks and eventually recovered, though he continued to refuse tests to whether he had contracted plague. His survival gave the Chinese Six Companies exactly the case that it had been looking for. With evidence that federal doctors had insisted on a diagnosis of plague only to see the patient recover, Chinese patients in federal care began routinely refusing all medical tests, further complicating efforts to save their lives.
Yet the case proved to be a blessing for federal doctors despite their apparent failures. With Wong’s help, Blue had successfully defused tensions between his men and Ng’s friends and relatives, prompting the secretary of the Chinese Six Companies to offer unsolicited praise for the “pleasant and courteous manner” in which federal doctors treated the Chinese. Instead of seeing in Blue a reincarnation of the “wolf doctor” Kinyoun, the Chinese slowly began to believe that Western doctors were sincere in their desire to save lives. Federal agents, meanwhile, began to see in Chinese immigrants a people deserving of respect and humane care, a radical departure from the openly racist complaints of Kinyoun and White. “I do not think the Chinese here are very different from the human race elsewhere,” one of Blue’s subordinates wrote in a letter to Wyman. “And it is my conviction that if they are dealt with in a certain manner, the ends that sanitarians desire can be far more readily attained, and likewise with the Californians. My opinion is the result of five months of daily association and patient observation.”
With Wong’s help, federal doctors discovered the body of Tom Chin Fat, a thirty-five-year-old cook, in an empty apartment at 125 Waverly Place. Little about the man was known. Anyone who could offer information about his background or recent movements around the city had fled “like fleas before the body cools off,” Blue wrote in a telegram to Wyman. An autopsy revealed swollen lymph nodes in the left groin and lower abdomen. Tests confirmed that they contained plague bacteria, making Fat the forty-second official victim of the disease in the span of twenty-one months.
The same day that Marine Hospital Service officials examined Fat’s corpse, Alexander Winters, a fifty-year-old white sailor, arrived at San Francisco’s Marine Hospital in the back of a horse-drawn cart. Though a sailor, Winters stayed close to home, ferrying schooners up and down the Sacramento River that brought goods ranging from bundles of hay to barrels of gunpowder into the city. The week before, he had suddenly begun vomiting while on a delivery run and run a high fever, which was followed by chills. He considered it nothing more than a bad flu until he came ashore in San Francisco and noticed a painful swelling in his right groin that made it difficult to walk. He checked into a room at the France House, a hostel at 149 Third Street then popular with sailors, and remained there as his condition worsened. After two days he fell into a stupor, and the men who shared his room took him to Marine Hospital. A tissue sample from the swelling in his leg revealed plague. Winters was placed in isolation, where he drifted in and out of consciousness, unable to give doctors any clues as to how he had contracted the disease.
Blue ordered his men to search for any connection between Winters and Chinatown, hoping to discover a link that would disprove his fear that the disease had again escaped the district. They combed through its brothels and opium dens for evidence that Winters had been there, yet found no links. “I would rather find a Chinese origin for this case, than to think that the sailors’ haunts on the waterfront were infected,” Blue wrote to Wyman, tempering his language so as not to reveal the full extent of his fears. “If we have then the two worst sections of the city infected, eradication of the disease is entirely out of the question, and the danger of an indefinite stay is enhanced.”
Winters gradually recovered, confusing the doctors all the more. Thirteen days later, Marguerite Saggau, a fifty-three-year-old immigrant from Bavaria, died at the German Hospital. She had been admitted two days earlier after fainting in her room at the Hotel Europa, which was located one block north of Chinatown at 628 Broadway. Doctors initially suspected that she was suffering a uterine hemorrhage, until a full body examination revealed a large bubo on her right thigh. She was rushed to the isolation ward, where she died the following day. An autopsy and subsequent tests confirmed that she was the forty-fourth victim of plague, and the second white patient discovered with the disease in less than two weeks.
Blue again grasped for a connection to Chinatown, praying that the disease could still be contained. He took long walks around the dead woman’s building, searching for clues that could connect her to the infected district down the hill, and traced all goods coming in and out of the Hotel Europa. He found nothing. The woman’s husband and son remained healthy, ruling out infected laundry as the source, and no other occupants of the building developed symptoms. Once again, the disease had seemed content to select one victim and slink back into the shadows. He kept coming back to an idea that could explain how the disease was spreading, though Wyman had dismissed it before plague ever appeared in San Francisco. Yet Blue could not help but notice the possibility. The woman’s home, he wrote in a letter to the Surgeon General, was only a few blocks away from Chinatown. That distance, he noted, was “a distance easily covered by rats in their migration.”
The rat is the most common mammal in the world, living in close proximity to nearly every known human habitation. It seems designed on the principle that it must be ready for anything: it is an excellent swimmer, is blessed with a sense of smell that can detect poison in food down to the level of one part per million, and is equipped with teeth that are stronger than iron. Its skeleton can collapse, permitting it to fit through a hole the width of its skull. That level of mobility makes it an ideal urban dweller, able to enter and escape spaces that otherwise seem impenetrable.
Should it find its path on the surface blocked, a rat has two choices, both of them good. It can scale nearly vertical walls made out of every common material, and, once it nears the top, can jump more than four feet horizontally, allowing it nearly unlimited range in a city. Should it fall, it can easily survive a tumble from a height of up to 50 feet, roughly equivalent to the size of a five-story building. If climbing is not an option, then digging is: rats are known to dig dense underground labyrinths, as far as two feet below the surface, and are able to move swiftly through pitch-dark spaces by using their
whiskers to guide them. Once introduced into a new environment, rats spread like a virus, their numbers expanded by a hyper fertility rate that can produce fifteen thousand descendants within a year from a single pair of rats. In environments densely laden with trash, rat populations can easily swell into the millions, making a significant die-off in their numbers unmissable by the human eye.
The link between a widespread die-off of rats and the arrival of plague has been obvious since antiquity, though the cause was uncertain. Ibn Sina, a Persian physician and philosopher whose eleventh-century tract The Canon of Medicine remains one of the most famous works in the history of science, noted that when plague was approaching, “mice and other animals which live underground fly from their holes and stagger from them like intoxicated animals.” The Byzantine historian Nicephorus Gregoras, in describing an epidemic in Constantinople during the medieval pandemic of the Black Death, wrote, “The calamity did not destroy men only, but many animals living with and domesticated by men. I speak of dogs and horses and all the species of birds, even the rats that happened to live within the walls of the houses.”
While Blue toyed with the idea that rats played a part in Marguerite Saggau’s death, he had little scientific evidence to rest on. Medicine at the time largely considered plague a disease of filth, and had few conceptions of how it was transmitted from victim to victim. Paul-Louis Simond, a French researcher, had made a breakthrough discovery four years earlier, yet his finding was not yet widely accepted. Simond, inspired by the competition between Yersin and Kitasato to identify the plague bacillus, had travelled to Bombay in hopes of claiming the prize of discovering its mode of transmission. Doctors fighting the outbreak hypothesized that the disease spread through some sort of contact—whether inhalation, ingestion, or via open wounds on the body—with the urine or feces of infected humans or rats. Simond, who had studied intestinal parasites in Paris, came to doubt that theory. Instead, he noted, the bodies of patients treated at an early stage of the disease all exhibited a small blister that contained a mix of fluid and plague bacilli. These blisters—the size of an insect bite—were followed by the emergence of buboes in the lymph nodes in the groin, neck or armpits.
Convinced that insects were spreading plague through their bites, Simond went searching for what species was capable of transferring the disease not just from person to person, but from rat to rat. After first considering the cockroach, he turned his attention to fleas. The problem he faced was how to catch enough of them for use in experiments. When no other method of collection presented itself, he began dunking dead rats found in the homes of plague victims into a bin filled with soapy water, where he would rifle through their fur with his bare hands and pick out as many fleas as he could. When he examined the intestines of the insects under a microscope, he found that the fleas were saturated with plague bacilli.
The following year Simond tested his theory in Saigon with live rats he had caught in the homes of plague victims. He placed a flea-infested animal in a small metal cage that was not quite large enough for it to turn around in. Next to it he placed another cage of a similar size containing a healthy rat that had had no prior exposure to plague. Wire mesh walls and a thick layer of sand under each cage prevented contact between the animals and isolated their droppings. However, six-millimeter holes in the cages’ screen allowed fleas to travel between them.
The rat taken from the home of a plague victim died on the second day of the experiment. Simond let its body sit for one additional day before removing it, giving fleas time to abandon the corpse and jump across the barrier to the still-healthy rat sitting nearby. An autopsy of the dead animal revealed an abundance of plague bacilli in the blood and organs. The healthy rat, now host to fleas from its dead neighbor, continued to eat normally for four more days, at which point it seemed to have difficulty moving. By the following evening it too was dead. An autopsy revealed plague bacilli in its kidney and liver. “That day, June 2, 1898, I felt an emotion that was inexpressible in the face of the thought that I had uncovered a secret that had tortured man since the appearance of plague in the world,” Simond wrote.
His breakthrough was met with skepticism by his peers, who had trouble replicating his findings and remained moored to the notion that uncontained urine and feces were the primary vector of the disease. Surgeon General Wyman, in an article about the plague prior to its appearance in San Francisco, cast doubt on Simond’s findings. “It is very possible that the fleas which infest rats, and which notoriously leave their bodies as soon as the cadavers become cold after death, may by their bites infect other rats,” he wrote. Yet, he continued, “it is much more probable that the fleas or other insects having their habitat on animals deposit their dejecta, and in this way infect their bites.” Instead of focusing on killing rats and their fleas to combat the disease, Wyman believed that doctors should work on cleaning up the soiled areas in which dead rats were discovered, largely through the copious application of boiling water. It wasn’t until 1903 that French doctors working in Marseille proved that plague could not be transmitted among rats without the presence of fleas, confirming Simond’s suspicion that the insect’s bites had caused millions of deaths throughout history.
Though Blue was familiar with Simond’s work, he did not have a chance to act upon his suspicions. The day after Saggau’s death, the body of Lee Wing See, the forty-nine-year-old owner of a cigar factory, was found at 12 Spofford Alley. An autopsy revealed multiple buboes on his right groin and red and purple hemorrhagic spots across his arms, chest and abdomen. Two days later, the body of Chew Ban Yuen, a forty-year-old cook, was found at 109 Waverly Place, a building notorious as one of the worst tenements in the city. The man had recently arrived by steamship from Alaska, where he had worked in a cannery, though Marine Hospital Service officials could confirm no other details about his life as the two men who shared his room had vanished before federal doctors arrived. An autopsy found not only plague in the lymph nodes of his neck but tuberculosis in both lungs, a venereal wart and a streptococcal infection in his throat. The rotting corpse of Wo Tai, a fifty-year-old dock worker, was discovered on October 10, 1901, in the same Waverly Place building. A bubo bulged from his left groin. The following week, the bodies of two Chinese men were found in the neighboring building at 106 Waverly Place, both containing plague. The disease then retreated, as if it were biding its time. As winter set in, the number of new cases slowed to a trickle, leaving doctors wondering if it was dying out or hibernating to gather strength for the year ahead.
The cat-and-mouse game of the disease finally proved too much for Blue. Depleted by the months of failure both personal and professional, he wrote a personal letter to Wyman requesting a temporary transfer back to Milwaukee. It was not in his nature to run away from problems, he said, yet he simply could not go on. He needed something familiar, something that once again reminded him that he was good at some aspect of life, in order to rebuild his pride after the shame of watching his marriage crumble and death spread under his watch while he was unable to stop it. Feeling always two steps behind the disease simply compounded his heartache, stirring in him a sense of fatalism that he had never before experienced. The people of San Francisco—from the mayor to the press to the Chinese immigrants most likely to be infected—refused to believe that they were in danger, and Blue no longer trusted that he could make a difference, nor had the energy to try to protect the city from its own arrogance.
“Only a widespread epidemic, one [people] could recognize for themselves, will change that,” he wrote in a letter to Wyman.
Deflated, with all sense of self-worth lost, Blue boarded a train bound for the cold plains of the Midwest, hoping that the open spaces would help him heal.
CHAPTER 11
AS SOON AS POSSIBLE
A short article in the San Francisco Chronicle in April of 1902 made Rupert Blue’s pain public. Its headline alone, “Dr. Blue’s Wife Secures Divorce,” was enough to cause a minor scandal in his hometown
of Marion, where the voluntary termination of a marriage was still rare. In her complaint, Juliette said that Rupert had failed to materially provide for her, adding another layer to his humiliation. Rupert had not seen Juliette since he left her family home in Washington, and soon learned that she was preparing to sail to Europe for the summer, no doubt intending to immerse herself in high society and the possibility of romance after the drudgery of life with him in the Marine Hospital Service. Rupert, now officially alone, remained in Milwaukee, where he braved a future that he had never imagined.
His entire life, he had measured himself by the example set by his older brother, Victor, and never before had he found himself falling so far behind. Victor was a war hero and married with two young children, all but completing the circle of expectations set out by the social codes of the South. Rupert was none of that, and now his shortcomings were laid bare for all to see. He retreated into his work, grasping on to the one link that remained between his vision of what his life would be and how it was actually turning out. On his better days, he forced himself to accept invitations to dances and cocktail parties thrown by members of Milwaukee’s upper crust, if for no other reason than to keep his social skills from atrophying from disuse. On other days, he spent more and more time in the boxing ring, hoping his fists could do what his brain had not and pummel his problems away. As he stood in the ring with his gloves on, delivering and receiving blows, he felt as if his body was exorcising the shame of the last two years of failure. The spread of plague in San Francisco was never far from his mind, yet he had no energy to return to the city and allow another defeat to enter his life.
With Blue no longer there to open doors and smooth over disagreements, federal doctors felt their influence in the city weaken. City, state and federal health officers were in open conflict with one another, leaving a coordinated response impossible. Under guidance from Governor Gage, state health inspectors began refusing invitations to attend the autopsies of suspected plague victims and would then claim that federal doctors were conducting them in secret and lying about the results. All attempts to force state health officials to acknowledge the reality of the plague were blocked, ignored or disregarded. One state doctor, when reached by telephone at his office by Marine Hospital officers informing him of the planned autopsy of a plague victim, pretended to be one of his clerks and said that his supervisor was away on business. Federal doctors grew so suspicious that one official wrote to Wyman and asked if the Secret Service could investigate whether state health authorities were working with the Chinese Six Companies to secretly dispose of the bodies of Chinese plague victims. “I regret [to] suspect Dr. Stone of such rascality, but I believe that he is perfectly suitable to such work,” he complained.