Plague and Fire

by James C. Mohr

  The Citizens' Sanitary Commission drafted a formal letter of protest against what they regarded as an unwarranted departure from "the radical policy heretofore inaugurated ... in destroying premises found, upon reasonable evidence, after investigation, to be infected by plague." In an ugly session full of angry demands and sarcastic replies, Thurston clashed openly with Emerson and Day. In the eyes of some, Thurston appeared bent upon using the Hotel Stables incident to put his Citizens' Sanitary Commission in command of the city in place of the Board of Health that created and authorized it. For five days, editorial after editorial implored the triumvirate to accept the demands of the Citizens' Sanitary Commission and burn the Hawaiian Hotel Stables, as they had previously burned the Pantheon Stables. As the rancor grew, U.S. military observers tersely notified Washington: "Situation at Honolulu horrible."'

  While the pro-government press pounded the doctors with headlines like "Duty Calls For Fire," another Chinese employee of the Hotel Stables came down with plague. This man, Ah Sing, died on February 26, and the Board held a special meeting to reconsider its wait-and-see position. Testimony was again confused and contradictory. Clearly, some parties were not telling the truth about which workers lived or did not live at the Hotel Stables; others challenged the identification of the dead man. A thoroughly exasperated Wood finally decided to accept the word of Ah Sop, a witness whom Wood knew personally, and concluded on the basis of Ah Sop's statements that the Hotel Stables should indeed be confirmed as a plague site. Though influential lawyers for the Hawaiian Hotel argued fiercely in favor of alternative forms of disinfection, the three physicians voted to burn the stable, a decision hailed in the press as overdue, and correct."

  Deaths from plague continued to occur from the end of February into the early weeks of March, though they did so in diminishing numbers and without apparent patterns. The seemingly random location of the deaths raised once again the possibility that Honolulu's remaining plague bacteria were being conveyed around the city in Asian foodstuffs, something the Board president had suspected all along. In his report about the situation on Maui, Wood had pointedly mentioned that the people of Kahului felt certain that plague entered their community on a shipment of Asian fruits and vegetables that had arrived shortly before the initial outbreaks. But the other two physicians tabled a resolution that would have committed them formally to the "official opinion" that "the continued cropping [up] of cases of plague in Honolulu seems logically chargeable to the presence of infection in Asiatic food stuffs." Moreover, despite Wood's protestations, his colleagues again declined to endorse the destruction of all "such Oriental food products as lie under strong suspicion of contamination." Deployment of two new disinfecting devices for foods and merchandise at wharves and warehouses, one a hot-air compartment and the other a steam-pressure chamber, helped mollify the Board president.`'

  With renewed deaths came renewed burning. On February 26, a Chinese man named Kee Mong was found dead of plague in a tenement house. The patient had been seen once prior to his death by the ever-needling McGrew, who claimed he declined "a large fee" offered by the dead man's friends "if he would give a death certificate that the patient died of some other disease." The Board physicians ordered the fire department to burn the tenement where Kee Mong was found, as well as the buildings on the Wong Kwai rice plantation, where the dead man had stayed while he was sick. The other residents of the tenement and the employees at the rice plantation were detained in quarantine camps. When a worker at the New England Bakery came down with plague, that shop was burned, as was the Globe Stables, where physicians discovered yet another case of plague. Employees of both businesses were sent to quarantine camps."'

  As the epidemic continued into March, the Board's physicians grew fearful that pestis might be riding dust particles around the city. To prevent that possibility, they ordered contractors to sprinkle the city's streets at night with a 5-percent solution of sulfuric acid. After the first few nights a local professor, who otherwise admired the Board physicians' commitment to the latest science, pointed out that Hawaii's porous and nonacidic soils would quickly neutralize the acid. Chagrined, the three physicians accepted his substitute measure: the application of unslacked lime at ten tons to the acre. If plague bacteria that had escaped the fires were lurking in the soil, the lime might kill them. Critics accused the Board's physicians of still not knowing how the epidemic was continuing to spreadhaving gone after buildings, rats, food, people, personal items, and now dust. They were right. But the critics had no answers either."

  Through these continuing frustrations, Emerson, Day, and Wood clung to hopes that laboratory scientists would develop effective serums and antidotes to counteract their invisible enemy. On March 5, eight doctors associated with the Board of Health, including Hoffman, met at Sloggett's house to organize the new Honolulu Microscopical Society.'2 The society's statement of purpose amounted to a manifesto on behalf of bacteriologybased medicine.

  The time has come when all progressive physicians, surgeons, general practitioners and specialists alike, must [have access to] skill in microscopic technique.... In no other way can they conscientiously perform their duty to those whose lives are placed in their hands, and fully meet the reasonable requirements of advancing medical science.... [W]ithout [microscopy] the practice of medicine and surgery would be little better than guess work. The microscope has wrought a complete transformation in the once dominant ideas concerning the treatment of epidemic and contagious diseases and especially may we boast of the truly wonderful advances made in bacteriology."

  Members of the Microscopical Society hoped to join Hoffman's efforts to find antidotes to plague. They knew that the U.S. Marine Hospital Service was trying to perfect something known as Yersin's serum-after the co-discoverer of pestis-which involved injecting horses with plague and extracting blood fluids that the horses produced to resist the bacteria. A similar technique had proved successful in creating anti-diphtheria serums. Since it would be several months before any of the new horse-based serum could reach Hawaii, the Microscopical Society decided to conduct experiments of their own in Honolulu. In the meantime, they waited for the next shipment of Haffkine's preventive serum that U.S. surgeon general Walter Wyman had promised more than a month ago. 14

  On March 12, the new batch, containing almost two thousand doses, finally arrived by ship from San Francisco. Since the first serums had produced such discouraging outcomes, Honolulu residents had grown skeptical of antiplague inoculations. Indeed, the Evening Bulletin revealed that Garvin found live pestis in the earlier batch of Haffkine's serum, though Garvin suggested somewhat unconvincingly that his slides might have been contaminated by a plague autopsy he had conducted shortly before preparing them. To win the public back, the three physicians decided to stage a dramatic demonstration."

  The day after the serum arrived, Wood summoned the press corps and announced that he would take the first injection from the new batch. He "thought it was only fair that he should be the first man to undergo the treatment and in this manner demonstrate to the public that the serum was harmless and unobjectionable, and at the same time ascertain in the interests of science and an inquiring populace just what the effect of taking the prophylactic would be." Day, Wood's lifelong friend, medical partner, and colleague on the Board of Health, accompanied the president into the Board's bacteriological laboratory and self-consciously declared that "as a worshipper of science,. . . [he] was not going to be left behind by his fellow-practitioner." The two doctors then agreed to inject each other, leaving their senior colleague in charge. "Professionally the two doctors were not in the least afraid," commented a reporter who witnessed the scene, but he detected "under their physicians' nonchalance ... just the smallest amount of trepidation.""

  Because public demonstration was the purpose of the episode, the press tracked the progress of the two physicians closely. Both men became seriously ill. Wood fought a high fever and extreme lethargy long enough to put in a symbolic appear
ance at Board headquarters, despite feeling "as if he had swallowed all the bacilli in the dictionary." He lacked the stamina to stay very long, and his obvious discomfort and visible shaking combined to produce exactly the headline he did not want: "Dr. Wood Sick." The press surmised that Wood's severe reaction to the serum probably resulted from his "arduous labor" and "tremendous responsibility" over the last three months, a period during which "Dr. Wood [has been] doing just about as much as it is possible for a man to do, in fact the doctor has been overworking himself." The press reported that "the people at large" were inquiring earnestly about Wood and "manifest[ed] a deep interest in his experiment with the serum." Day was a bit less violently ill, but remained in seclusion, telling reporters he was "uncomfortable.""

  Following two more days of intense discomfort, Wood finally phoned the Advertiser to say he was recovering. Editorials expressed relief that "the head of the fighters against the plague" would shortly be back on the job. The following week, with less publicity, Hoffman also injected himself with serum; he also got quite sick, but recovered fully. Relieved and reassured, ordinary citizens began cautiously to come forward to receive inoculations, which Board physicians provided at no cost."

  Most numerous among the early volunteers for inoculation were Honolulu's Japanese residents. Since the Board made inoculation a condition of travel to the outlying islands of the archipelago, the Englishlanguage press surmised that the possibility of obtaining jobs on the plantations of Kauai, Maui, and Hawaii must have been motivating the Japanese. While those assumptions were partly correct, whites beyond the Board of Health seemed completely unaware that cultural factors among the Japanese themselves were also playing a significant role. Well before the arrival of plague, Japanese physicians in the city had regularly filled Yamato Shimbun, the leading Japanese-language newspaper, with advertisements touting their use of the latest and most scientific medical technologies, including bacteriological inoculations.19

  Mori Iga was a good example. Mori had attended the Japanese Naval Medical School in the late i88os, where the Meiji government insisted on teaching the latest Western curriculum. He then earned his MD in 1891 at Cooper Medical School in San Francisco before coming to Hawaii to serve as a government physician for the surge of incoming Japanese laborers. Mori had also gone briefly to London in 1898 to study at University Hospital. For several years prior to the arrival of plague, Mori had publicly advertised himself in Honolulu as a particular specialist in vaccinations and inoculations. When plague did appear, Yamato Shimbun reported the efforts underway in bacteriological laboratories worldwide to develop vaccines to combat the disease. Kitasato's heroic stature as a scientific warrior battling the pandemic back home with bacteriological weapons also helped make Honolulu's Japanese colony (as they called themselves) more accepting of bacteriology, and hence of serum inoculations, than any other group in the city.20

  As more and more people underwent the prophylactic inoculation without grave side effects, the initial lines of ten volunteers a day turned into scores. Anonymous individuals floated the idea of making inoculations universal and compulsory, but their suggestions were dropped when opposition to mandatory inoculation surfaced almost immediately in the English-language press. Even so, the Board physicians were running out of serum by the end of March. They sent an urgent message to the Hawaiian consul in San Francisco to try to obtain another 250 flasks from Washington. If that was impossible, the consul was instructed to cable the Pasteur Institute in Paris with the same request. In the meantime, Carmichael agreed to augment the city's supply of serum from his own military stores. By the end of April, the Board had inoculated close to two thousand people in Honolulu and was considering charging future patients for the service to generate revenue for the financially strained government.21

  In contrast to the preventive serum, the therapeutic applications proved ineffective against cases of plague already contracted. When Herman Levy, a day clerk at the Hawaiian Hotel, came down with what initially appeared to be plague, he asked to be admitted to the special pest hospital for treatment. Hoffman administered several doses of a new serum he hoped to use against active cases of plague, and Levy improved. Emerson, Day, and Wood rejoiced that the sharp young bacteriologist, whom they trusted even before the plague arrived, had now found something that might help stop the epidemic. But when Levy made a rapid recovery with no further evidence of plague, even Hoffman concluded that Levy had probably been sick with something else all along, so the serum had not cured him of plague.22

  Egged on by McGrew, who later examined Levy and declared him to be suffering from pneumonia, Levy's father, a prominent rabbi in San Francisco, subsequently protested the triumvirate's treatment of his son, alleging poor diagnosis, discrimination, and-most aggressively-the administration of dangerous inoculations. Herman Levy himself, however, defended the Board's physicians completely, pointing out that he had received the best possible care and attention, and he offered the firm opinion that Hoffman had done the right thing to administer his serum under the circumstances. Yet Levy's case could not be counted as a triumph for the plague antidote. While Board physicians continued to administer various batches of serum to other plague patients, none of the injections retarded cases already contracted.23

  Following the widespread administration of preventive inoculations, the number of new plague cases resumed its downward trend. The three physicians did not know whether the reduction resulted from the cumulative effects of their ongoing fire policy, from the inoculations, or from a combination of both, but they were grateful for a chance to relax some of their emergency measures and prepare the city for an eventual return to normal routines. To a large extent, their official actions merely ratified what was taking place anyway as the epidemic slowed. Outside Honolulu, residents stopped enforcing quarantines that were theoretically still in effect. Inside the city, daily health reports began to fall off as Citizens' Sanitary Commission inspectors felt less urgency to keep repeating "no new cases. "24

  Emerson, Day, and Wood happily took the declining number of inspectors' reports as a reason to disband the troublesome Citizens' Sanitary Commission altogether and replace their legions of volunteer inspectors with a small corps of paid agents-including some women (the Citizens' Sanitary Commission had refused to appoint female inspectors)whom they could choose personally and monitor directly. Since the number of permanent paid agents would be no more than a small fraction of the number of volunteer inspectors that previously circulated through the city under the aegis of the Citizens' Sanitary Commission, this decision effectively ended the city's state of constant surveillance. In lieu of continuous oversight, the three physicians announced a reward of a hundred dollars for anyone reporting a suspected plague case. "Such an offer," they reasoned among themselves in private session, "may induce a man's friends or enemies to report his case."25

  The three physicians also permitted contractors to resume construction in most parts of the city-though not yet in Chinatown-provided all structures met their tough new sanitary regulations. The city's newspapers printed those revised codes in serial form throughout the month. Included in the first round of new building permits were several that went to Chinese and Japanese citizens. Even at the end of the month, however, despite intense pressure and another exchange of "strong talk" with Honolulu's shippers, the Board physicians refused to loosen their tight restrictions on trade, citing the continued outbreak of occasional plague cases. Indeed, the very day the merchants had their most acrimonious showdown with the triumvirate so far, two new cases of plague appeared. Both patients died the following day, March 2 5.26

  Near the end of March, Wood announced his intention to resign as president of the Board of Health. He was depleted, he said, physically and financially. He had expected the battle against plague to last about a month, but it had lasted more than three months. He had been forced to abandon his own medical practice, and he seldom had any time to spend with his wife and two small children. Having led
the most intense part of the campaign against plague and having served as de facto dictator of Hawaii through some of the most trying months of its history, he was exhausted. "I would not serve again for $ro,ooo," he told the press, and asked his two compatriots on the Board to find someone else to oversee the remaining mop-up operations.

  Editorials praised Wood and called for "some substantial recognition" of this physician who "battled the plague at its worst ... without salary." His colleagues appointed Wood to a special committee to nominate a new president, thereby insuring him a major voice in the selection of his successor. The pro-government press speculated wishfully that longtime Dole confidante George W. Smith would probably take over, but instead Wood secured the appointment of his lieutenant from the Kahului episode, thirty-one-year-old Charles Garvin, to serve as a sort of executive secretary or ex officio president. Garvin was recalled from Maui to relieve his mentor from the management of day-to-day affairs, allowing Emerson and Day to ceremoniously decline Wood's formal resignation as their official president.27

  Garvin's elevation as de facto president kept a bacteriologically oriented medical doctor at the helm of Hawaii's ruling authority, but the major trials he faced through the rest of March and April turned out to be financial and legal rather than explicitly medical. From the outset of the plague crisis, and certainly since the initial implementation of the fire policy, Emerson, Day, and Wood had operated under the assumption that losses imposed by governmental agencies for purposes of protecting the general welfare would be compensated. Assessors had regularly and formally recorded the value of all condemned property prior to its destruction, and that practice was continued for the duration of the emergency. But in addition to predictable disputes over who owned what and exactly how much it was worth, the Board's physicians faced two much larger and more difficult problems: Where was the money for reparations to come from? And how should they determine the value of losses not assessed in advance, which included everything lost in the Chinatown fire?