These divisions complicated the handling of specific situations. R. E. Lockwood, for example, a frustrated subdistrict inspector who worked for the Citizens' Sanitary Commission, repeatedly reported a Chinese laundry and a Chinese store near the corner of Beretania and Emma streets to be unsanitary. He considered them "worse than in Chinatown a few weeks ago ... foul," and wanted them burned. When the three physicians on the Board of Health failed to take action on his reports, Lockwood sought outside medical support to bolster his opinion, and readily received it from John McGrew, the former Medical Society president; Luis Alvarez, who back in December had written a public letter doubting Hoffman's bacteriological evidence of plague; and five other veteran physicians from the Medical Society. Despite pressure from Lockwood's seven allies, Emerson, Day, and Wood still refused to destroy the structures because no plague cases had occurred in them. Rather, they told the attorneys who represented the owners and tenants of the buildings to bring them up to code requirements or face penalties.'
Differences among Honolulu's white doctors surfaced again in an incident that occurred a week after the great fire. Late in the afternoon ofJanu- ary 2 7, arsonists ignited a largely abandoned block of shacks adjacent to a Chinese theater in the Aala district of the city. The resulting fire destroyed roughly thirty run-down structures over an area of about six acres before Chief Hunt's firefighters finally contained it with the help of employees from the Oahu Railroad Company, whose depot was downwind of the blaze. No one disputed that the ramshackle block ignited by the arsonist was an exceedingly foul site. Indeed, at the insistence of the Citizens' Sanitary Commission inspector for that part of the city, the Board's three physicians had previously designated the block as officially unsanitary. "But," as the Advertiser pointed out, "there had been no case of plague in [that block] and it had not been condemned to be burned." Instead, the Board physicians had tentatively planned to fill the area's cesspools, empty its garbage pits, and regrade the surrounding land, probably after the immediate crisis of the plague epidemic was over. In defiance of that decision, medical sanitationists sympathized publicly with the act of arson-which in their view accomplished something Emerson, Day, and Wood lacked enough guts to do.'
During the week following the Chinatown fire, when most businessmen and ordinary citizens were pitching in to help restabilize the city, the three exasperated and overtaxed doctors on the Board of Health "made emphatic reference to the lack of assistance on the part of the medical fraternity of Honolulu, that is, from the majority of those who are practicing physicians." The press tried to drum up support for the triumvirate running their city by pointing out that "important communications, delegations from Chinese and Japanese sources, reports of special committees and the detention camp superintendents, the issuance of instructions and orders, visiting different posts, listening to complaints and personally attending emergency calls for a physician, prove a burden which should be relieved as much as possible by others." But beyond those doctors who had been helping from the outset, no one came forward.7
The limited number of medical volunteers forced the Board's physicians to reduce the other services they usually provided the people of Honolulu. Prior to the plague crisis, for example, Henry Sloggett, a graduate of Edinburgh Medical School, had maintained the Board's Eye and Ear Infirmary. That infirmary treated indigent patients free of charge, primarily because Sloggett himself took no salary for his public services. But with so few medical professionals coming forward to help, the triumvirate needed Sloggett's assistance more urgently in the campaign against pestis than at the clinic-especially since Sloggett knew how to prepare bacteriological slides. So they were forced to close the infirmary and redeploy him in support of Hoffman. By the end of January, the triumvirate was so shorthanded that the stalwart band of volunteers who had stood with them since December began taking turns sleeping in the Board of Health office so someone would be on duty for plague-related emergencies at all times."
Emerson, Day, and Wood bitterly resented the lack of cooperationeven outright opposition-they were receiving from so many of their European and American medical colleagues. Besieged on several fronts and facing enormous tasks ahead, their own morale flagged badly in the wake of the great fire. Since becoming Board president, Wood had been forced to abandon his private practice completely and was working essentially around the clock as Hawaii's de facto chief executive. Ever strongwilled and determined, he took challenges to the Board's policies personally, and his interviews with reporters grew noticeably testy as the city's press corps probed alleged mismanagement and questioned the medical triumvirate's decisions.
Emerson and Day also spent most of their waking hours on Board matters. The situation strained the family lives of all three doctors, exacting heavy financial and psychological sacrifices. Back on January 4, Emerson had written confidently to his sister about the campaign he and his two colleagues on the Board were waging against the plague epidemic. "I am not enough of a prophet to foresee when the end will be," he wrote. "But there will be an end, and we shall all see it and rejoice." Now, twenty days later, he was feeling considerably more despondent. Instead of reaffirmations of victory ahead, he wrote a last will and testament into his small notebook, declaring his wife Sarah his sole heir. He had Day solemnly witness the document.9
The relentless pressure of the plague campaign also took a heavy toll on the personal life of the Board's most crucial outside medical supporter, Carmichael from the Marine Hospital Service. With the city's crisis commanding more and more of his attention, his marriage of six months began to fall apart. What seemed like a marvelous match the previous July turned into a nightmare after the great fire, as the new Mrs. Carmichael exercised her violent temper in fits of outrage, sometimes storming off to stay with friends and threatening to divorce the public health doctor who seemed to be neglecting her.'o
Though the situation in Honolulu following the great fire nearly overwhelmed the exhausted medical team battling pestis, the conflagration did retard the progress of the epidemic. The daily death tolls, which had been rising prior to January 20, abruptly leveled off and then declined through the end of the month. The day after the fire, an eight-month-old Chinese baby died of plague in his parents' home near the Oahu Railway station, but the three physicians decided the case had been introduced from Chinatown prior to the fire. They all knew the case personally, since the baby's father was one of their employees. For the entire week preceding the fire, he had been handling goods removed from condemned properties for fumigation and storage, so the doctors assumed that he had somehow tragically brought the disease home to his child. But to prevent the bacteria from establishing another new beachhead, the physicians felt they had no choice but to burn the family's house and quarantine the grieving parents.
To the great relief of Emerson, Day, and Wood, the resettlement camps remained free from fresh outbreaks of plague. Only one death from disease of any kind was reported in any of the city's sprawling camps: a twentythree-year-old Japanese man who had lived in the same block as Kaumakapili Church was found dead at the Kalihi camp the day after the fire, but whatever killed him was not plague. Emerson credited the lack of plague cases to the Board's insistence on thoroughly disinfecting both people and goods inside the camps, and to the policy of separating those who had direct contact with prior plague cases, such as "husbands & wives, sweethearts, and nurses," from those who did not."
Elsewhere around the city, the epidemic slowed to sporadic cases, like that of Ng Gee, which popped up unpredictably in seemingly random places. Wherever they occurred, the three physicians continued to condemn the affected property and the fire department continued to burn what the Board condemned. On January 30, for example, firemen burned a shack above Wyllie Street where a Chinese man named Quong Fat Man had been found dead from plague. But that case worried the Board's physicians more than most because it seemed to suggest that some Chinese had resumed the practice of transporting plague patients away from residentia
l or business properties, lest those properties be condemned. Their suspicions rose when passersby began to discover other Chinese bodies in improbable locations."
The total number of deaths continued to dwindle through January, and by the end of the month both the English-language press and the Board's physicians were beginning to sound more optimistic than either had been since the great fire. On January 30, the front-page story of the Advertiser happily announced, "No Deaths Yesterday: Plague Seems to Be Abating." Daily editorials began looking to the future rather than commenting on the troubles of the previous day. Welcome news arrived from Washington, D.C., that the United States government would help underwrite any expenses incurred as a result of fighting the plague in its recently annexed archipelago. Citywide discussions also got underway about various long-term redevelopment ideas for the area destroyed in the great fire. Emerson, Day, and Wood held public meetings with Chinatown property owners to hear their opinions about redevelopment and listened for hours as engineers debated alternative plans for rebuilding the area with filtered water systems and sanitary sewers.13
The triumvirate's renewed optimism suffused a long private letter they wrote jointly on January 31 to their counterparts on the Board of Health of Sydney, Australia. Facing an attack of plague themselves, the Australians had written the Hawaiians for advice, which Emerson, Day, and Wood were now more than willing to offer. Their basic program for the last month, the Honolulu physicians told the Australians, "was to get the people out of their infested district and to provide for them in a Detention Camp in order to be able to disinfect such buildings as could be disinfected, and to destroy those that could not be rendered sanitary." The fact that plague had not broken out in the detention camps, deduced the Honolulu physicians, "seems to clearly show that it was the locality and not the people that were infected." Though we have lost twenty-six Chinese, seventeen Hawaiians, nine Japanese, one German, and one American, they wrote, our policies appear to have been effective, and "we now have the situation well in hand."14
Adding to hopes for the future were Walter Hoffman's ongoing experiments to develop a serum or an antidote for plague, using the samples of pestis bacteria he had been carefully collecting and cultivating as he performed his autopsies on the city's dead. Hoffman was working on variations of a process the British had tried to use in India in 1899, which involved culturing substantial amounts of plague bacteria; killing them by subjecting them to high heat; extracting fluids from the dead bacteria; and injecting the fluids, which were called Haffkine's serum after the developer of the technique, into humans in varying concentrations and amounts. Though the serum had done nothing to help patients already infected with plague, the injections had shown some generally positive results in immunizing healthy recipients against subsequently contracting the disease."
Hoffman was trying to prepare enough of the serum not only to inoculate people staying in Honolulu, but also to offer inoculation to anyone who might now wish to leave the city. Since Honolulu remained an official plague port in the eyes of the world, people headed elsewhere would need a certificate of immunity to disembark at their destination. He also offered his serum to anyone from Honolulu who wanted permission to travel elsewhere on the island of Oahu. Angus Smedley, a Mormon missionary, remembered arriving at Honolulu during this period. After being inspected by quarantine officers, he and his friends went directly "to the Board of Health office and received an injection in our arms of Haffkins [sic] Prophylactic for the prevension [sic] of Bubonic Plague. Our arms pained us some and brought on a fever, but we were soon over it. We all took the injection so we could go to the Church Headquarters at Laie."16
Bright and ambitious, Hoffman-along with scores of other pioneer bacteriologists working at the same time all around the globe-hoped that his efforts might somehow produce bacteriology's next big breakthrough: the conquest of the legendary black death. But even if his own experiments with new methods of serum-making proved futile or insufficient, the young medical scientist knew that he would soon be receiving bacteriological reinforcements in the form of plague serums from elsewhere. Through his friend Carmichael, he had asked the Marine Hospital Services laboratory in Washington, D.C., to send anything they came up with that might help; and through his own European contacts, he had received assurance from the Pasteur Institute laboratories in Paris that they would do the same."
The situation in Honolulu looked sufficiently hopeful by the first week of February that Hoffman, who had gone a week without having to perform a postmortem exam, took time off from his work on the serum to get married. He had met his bride, Katherine McNeill, shortly before the plague crisis began, when as a member of the Boston Lyric Opera Company she had come to Honolulu to sing. She fell in love with both the city and the young German aristocrat-though she was more than twelve years older than he-and when their engagement was announced after the epidemic struck, she was quoted as saying, "Even the plague can't drive me out." McNeill indirectly strengthened the Board's strong medical ties to Chicago, since she had lived there as a child, the daughter of a doctor. Fittingly, Hoffinan's close professional friend Day, another ex-Chicagoan, served as best man at the wedding."
While the Hoffmans honeymooned, the missionary press thanked God for the "rigid and vigorous sanitary measures so strenuously carried on by the Board of Health, and actively aided by the intelligent citizens of Honolulu. Segregation, disinfection, purgation by fire, and the thorough twice a day inspection of every dwelling, have produced marvellous [sic] results. There seems to be the strongest prospect that our city will soon be entirely delivered from the `Black Death,' and cease to be dread to all around us." Public discussion among Honolulu's white elites continued to focus on hotly debated alternative proposals for redeveloping Chinatown. Public discussion among refugees in the detention camps and among their spokesmen outside the camps shifted from recriminations to reparations.19
The city's optimistic mood collapsed abruptly on February 3, when J. Weir Robertson, a white grocery store employee, came down with plague. A quiet man who had been in Honolulu for twenty years and was said never to go out at night, Robertson lived in a residential area off upper Nuuanu Street, immediately behind the home of the head sanitary inspector for his neighborhood. Earlier that week Robertson had proclaimed himself the winner of an informal rat-catching contest among the downtown grocers, and his casual handling of the dead rodents almost certainly produced his case of plague. But no one knew anything about the ratcatching contest when president Wood responded personally to an ur gent message sent to the Board of Health office by Robertson's physician. Wood quickly concurred with Robertson's doctor that the case was almost certainly plague and ordered the patient removed to the city plague hospital. Robertson's fourteen-year-old daughter and the nurse who was attending him were both sent to the Kalihi detention camp. Honolulu awoke to front-page headlines: "White Man Stricken . . . on Nuuanu Street. 11211
The same day Robertson came down with plague, the first shipment of plague serum arrived from abroad. The Marine Hospital Service in Washington, D.C., had forwarded a hundred vials of an "anti-pestique" serum, which the Pasteur Institute hoped would be effective against active cases of plague, and a thousand vials of Haffkine-type prophylactic serum. The French bacteriologists who produced this batch of Haffkine serum warned their American colleagues that people might feel ill soon after being injected with it, but they thought it would probably begin providing some immunity after ten days. Officially the serums were all sent to Carmichael, but he immediately put them at the disposal of his friends on the Honolulu Board of Health. Though the anti-pestique preparation was completely untested-its makers had requested a full report regarding its effects-Wood and Carmichael agreed to permit Robertson's physician to administer the purported antidote to his patient. No one knew how much serum was supposed to be used under any given conditions, but the three physicians settled on two vials for Robertson-a bit less than a quarter of a cupful-which his doctor then injected i
nto his back with a large hypodermic needle. As the press reported, with unintended understatement, "The medical fraternity will watch developments in Mr. Robertson's case with interest on account of the trial being given the new serum."21
Since the prompt administration of the prophylactic serums seemed less urgent than prompt administration of the anti-pestique that might save Robertson's life, the doctors decided to test the Haffkine preparation on a guinea pig before administering it to humans. Preparation of these prophylactic serums was still rather ad hoc, and batches were known to vary in strength and side effects, hence the warning that accompanied this batch. If the guinea pig survived, the Board's own physicians, starting with president Wood, offered themselves for the initial human trials. The three physicians also learned from the French consul in Honolulu that his government had instructed the Pasteur Institute in Paris to send twenty-five vials of a different batch of anti-pestique directly to the consul for use in Hawaii as he saw fit. Those doses were expected on the next steamer from San Francisco, and the French consul would almost certainly offer them to the physicians on the Board of Health. Finally, Hoffman's own serum preparations were expected to be available shortly."
Results from the Robertson experiment were not long in coming: he died within twenty-four hours of his two injections. A postmortem examination confirmed that his body was riddled with the aftereffects of plague. Perhaps, speculated the Advertiser, "the remedy lost some of its virtue in transit, just as vaccine matter is said to do." Truly fair tests would have to wait "until the fresh serum being prepared by Dr. Hoffman is available." Also ominous was a laboratory report that arrived on the day of Robertson's death regarding the recent demise of a Chinese man. Doctors at the time had not attributed Wong Chin's death to plague, since they had not found any plague bacteria in their initial examination of his remains. But as a safety precaution, they had dropped some of his bodily fluids into a "culture tube" for later exploration. The bacteria that subsequently developed in the culture tube proved to be unmistakably those associated with bubonic plague. Retroactively, Wong Chin was declared a plague victim.23
Plague and Fire Page 20
