by Black Death at the Golden Gate- The Race to Save America from the Bubonic Plague (retail) (epub)
The one man who could determine whether a quarantine was needed sat five miles away in a windblown island laboratory that was still far beneath his standards, unaware until it was too late that anything had gone wrong. Kellogg arrived at Angel Island at dusk carrying samples of tissue taken from the body from Wong Chut King as the first ropes were being strung up around Chinatown. He greeted Kinyoun and filled him in on the possible buboes found on the dead man in nearly the same breath.
Kinyoun took the samples and hustled to his laboratory, where he began the grim process of determining whether the scenario that haunted his nightmares had become real. First, he peered at the cells through the microscope, looking for the distinctive rod-shaped bacillus. Once he confirmed its presence, he separated a part of the tissue sample and divided it into syringes which he injected into two guinea pigs, a rat and a monkey which he kept in cages in his laboratory. Should the animals develop the same symptoms as the dead man over the next few days, it would be powerful evidence that the plague was real and could spread. Once this was done, he examined the remaining material collected from Wong Chut King’s body, hoping to isolate a selection of bacteria cells that he could grow in a culture in order to confirm the identity of the disease.
He was among the few doctors in the world who knew enough about the disease to even attempt to regrow it in a laboratory. The bacillus responsible for plague, now known as Yersinia pestis, had been identified just six years before. This discovery was one of the most notable achievements in the still-young field of bacteriology, and yet it cratered the reputation of one of the field’s early stars.
In May of 1894, the Japanese government sent a team headed by Shibasaburo Kitasato—who, alongside Robert Koch in Berlin, had conducted the diphtheria research that had amazed Kinyoun, and whose brilliance would eventually lead the Emperor of Japan to grant him the title of baron—to Hong Kong to research the outbreak of plague decimating the city. Nearly half of the 100,000 residents had fled, leaving the roadways deserted and the harbor nearly empty. Great piles of dead rats lay untouched in infected areas, casting a stench of death that hung like a warning over the city and could be picked up from miles away. Within two days of his arrival, Kitasato was at work in a modern laboratory provided by the government, built in a former police station which had been converted into a plague hospital. There, with six assistants on hand, he searched for the organism behind the wave of disease spilling through the city, which threatened to leave Hong Kong nothing but a ruin.
A few weeks after Kitasato arrived, a Swiss-born French researcher by the name of Alexandre Yersin entered the city without fanfare. Like Kitasato, Yersin had studied at Koch’s laboratory in Berlin, but after publishing a few landmark papers he left behind a promising career to travel alone to the newly united French colony of Indochina, hoping to follow in the footsteps of his hero, the British explorer David Livingstone. Short, shy and solitary by nature, Yersin preferred experimenting with the new technologies of radio and photography to the company of people, and adopted the peculiar habit of never using his first name if he could help it. He was only allowed into Hong Kong on the recommendation of one of his former mentors, Louis Pasteur, whom he had once dazzled with his accounts of wandering through present-day Vietnam. Once in the city, he spoke rarely, knowing only a handful of English words and possessing no desire to learn more.
Alone, without facilities, housing or government support, Yersin began his own experiments with a microscope and portable sterilizer, searching, like Kitasato, for the elusive cause of plague. He built a straw hut that functioned as both his laboratory and shelter and petitioned the government for cadavers for research. After being denied, he found more success by bribing sailors who were carting plague-infected bodies to cemeteries. Though Yersin knew Kitasato socially, he spoke to the man just a handful of times, conversing in their shared tongue of German. Both men were well aware that the other was pursuing the same goal, and a quiet rivalry developed between the two.
Yersin attended one autopsy conducted by Kitasato, and was struck by the fact that he was concentrating his attention on the cadaver’s blood, rather than on the buboes in the groin and armpits. Yersin, by contrast, focused almost exclusively on the swollen buboes pocking the dead, a decision that soon proved fruitful. On June 20, he wrote the first description of the bacterium responsible for killing millions since antiquity. “The pulp of the bubo, in every case, was filled with a thick puree of short, thick bacilli with rounded ends . . . One can recover a great amount from the buboes and lymph nodes of the diseased. The blood also contains them but not in such great numbers and only in very grave and deadly cases.” Mice, rats and guinea pigs injected with diseased tissues died two to five days after infection, he reported. The location of the bubo did not seem to matter, he found, as tissue extracted from various organs all yielded the same quantity of bacilli, a stark sign of how thoroughly plague consumed the human body.
Kitasato, for all of his material advantages, was unable to pinpoint the plague bacillus as rapidly, sharing the results of his research only in mid-August. Though his observations were similar enough to Yersin’s that the two men shared recognition for the discovery during their lifetimes, Kitasato made several telling errors in describing the plague bacillus, which led to whispers among his contemporaries that his cultures had been at least partly contaminated. Researchers following in Kitasato’s footsteps the following year realized that, on at least one occasion, the lion of Japanese research had instead isolated the bacterium responsible for causing pneumonia, remarkably similar in shape and size to that behind the more devastating disease. A proud man who hoped to return to his home country and open a research institute bearing his name, Kitasato refused to admit his error until 1899, when plague reached the Japanese port city of Kobe, and then did so only privately. He conceded to a team of doctors hoping to forestall the epidemic that he had been mistaken, but continued to insist that the culture in question was not pneumonia but another, still-unidentified bacterium associated with plague.
Though driven by a need for medical certainty that made him look to disprove the research of others as much as to conduct trials of his own, Kinyoun accepted Kitasato’s errors without judgment, still mesmerized by the older man’s research into diphtheria, which had saved the lives of countless children. Kinyoun maintained a friendship with him for the remainder of his life, humbled to be in the presence of one of the few men he considered his intellectual superior. Kitasato, in turn, shared samples of Yersinia pestis with Kinyoun, making him the first American to study the bacterium. Long before he came to San Francisco, Kinyoun had spent hours in conversations with Kitasato, questioning him on every aspect of the plague epidemic in Hong Kong.
It was because of these talks that Kinyoun was perhaps the only person on the West Coast, and one of a handful in the entire country, who truly understood the progress of the disease he was fighting. A single infected patient arriving in a new city didn’t spark a wide epidemic, he learned; the disease instead seeped slowly into the marrow of a city, only exploding out of a small zone once it had thoroughly established itself. The mechanism by which plague traveled from person to person was not yet fully known, however, leaving doctors grasping for ways to halt its spread or eliminate it completely.
Medicine at the time could only detail the methodical way in which plague consumed the body. After penetrating the skin of a human, the bacterium would begin to rapidly multiply, as if intent on overwhelming the body’s defenses through sheer numbers. The bacteria were found to double within the human body within two hours, and then double again every two hours thereafter. White blood cells, the body’s natural defenses, would soon be rendered helpless as the plague bacteria developed antigens that allowed them to overrun the lymphatic system. Within a week, patients infected with the disease would develop a bubo laden with as much as 100 billion plague bacteria per gram of tissue and fall into a stupor. The appearance of a bubo was an all but certain sign of death, with
nearly all patients dying of organ failure within five days after one emerged on their body.
Modern scientists now understand that Yersinia pestis seems designed to kill. The bacterium has the ability to detect temperature around it, and once it is in an environment around the human body’s resting state of 98.6 Fahrenheit it begins to modify the structure of a molecule in its outer membrane in an effort to mask itself from the immune system. The bacterium then moves toward the lymph nodes and destroys protective white blood cells known as macrophages by injecting toxins into them. Once inside the lymph nodes, Y. pestis releases a molecule called yersiniabactin which scours the bloodstream for iron, allowing the bacterium to replicate further while pushing its victim into an anemic stupor. The lymph nodes begin to swell, forming buboes, and the overabundance of bacteria in the bloodstream soon sends the body into septic shock, leading to abnormal blood clotting and organ failure.
While physicians knew the progression of the disease at the turn of the twentieth century, antibiotics, which might halt it as it ransacked a body, had yet to be developed. Instead, isolating a patient with the disease was the closest thing that medicine had to a cure. As Kinyoun readied the culture of cells, he knew that he was racing time. It was only by chance that the police had come across Wong Chut’s body; perhaps other men and women had succumbed to plague over the last few months or years without notice, shortening the window that Kinyoun had before the disease was so well-established that all of San Francisco was at risk.
From nearly the moment he received the samples from Wong Chut’s body, Kinyoun found himself thrust into a world for which he was uniquely unsuited. Used to the safe confines of his laboratory, he now faced a city that had no patience for a man who valued certitude over speed. His pride made him unable to consult with others who might offer guidance on how to smooth the political edges of his task; his lack of social graces left him with no network to draw on should he need it.
Even his fastidious routines—so useful in the pursuit of scientific truth—would soon be criticized, as the anxious city found itself unwilling to reconcile the methodical pace of the new era of science with the hourly demands of modern life. With few acquaintances and no close friends in the city, Kinyoun had no one to confide in. “I would like very much indeed to have some congenial spirit with whom to commune and hear out my worries, who would be a little closer than twenty-five hundred miles away,” Kinyoun lamented in a letter to a friend in Washington.
Forty-eight hours after the quarantine was put in place, Phelan called an emergency midday meeting of the Board of Health. There, Kellogg announced that although Kinyoun’s tests would not be conclusive for at least another day, “I inspected the inoculated animals today at Angel Island and found no indication of infection from the cultures injected, and I do not think now that the case is one of plague. Unless the animals die there will be nothing more to do; the incident will be closed.”
With no input from Kinyoun, and with no one willing to wait until the test which could determine that the fate of the city was fully concluded, the Board of Health voted unanimously to lift the quarantine. Outside, Mayor Phelan proclaimed that the board had been justified in its decision to impose a temporary quarantine despite the disruptions that it caused, due to the city’s position as the first line of defense against the “Asiatic infection to which San Francisco is constantly exposed.” Phelan, who would later be forced to admit that he owned buildings in Chinatown from which he extracted exorbitant rents, then continued, “As to the objections and suits by the Chinese, I desire to say that they are fortunate, with the unclean bits of their coolies and their filthy hovels, to be permitted to remain within the corporate limits of any American city. In an economic sense their presence has been, and is, a great injury to the working classes, and in a sanitary sense they are a constant menace to the public health.”
Within hours, the ropes encircling Chinatown were cut down, sending hundreds of Chinese residents rushing out of the quarter to their jobs, where they hoped to confirm that they were still employed. Trash collectors making their first forays into the district for days found streets thick with spoiled meat and rotting vegetables. Hoping to prevent the city from imposing a similar quarantine in the future, Chinese merchants and the powerful Chinese Six Companies pressed for reimbursement for the hours their businesses had been forced to close and the merchandise that had expired. “If we do not protest and demand compensation, the Americans will only treat us even more cruelly,” the Chinese-language newspaper China West Daily argued.
Lost amid the relief spreading through the city, Kinyoun was now the sole person left seeking the true cause of Wong Chut’s death. His refusal to call off his tests made him a target for those in the city hoping to quash all mentions of plague. In a damaging blow to his pride, the Chronicle reported that “the quarantine officer is said to have one time diagnosed the germs of pneumonia as those of the black plague,” misattributing Kitasato’s error to Kinyoun. Not content with undercutting Kinyoun personally, the paper then mocked his methods, suggesting in an editorial that he needed to add a parrot into his menagerie for entertainment value alone. At least then one animal would “have been able to tell how it felt to have a lot of germs from a dead Chinese injected into his veins, and until the germs and starvation causes death, if the experiment resulted that way, the parrot might have joined forces with the monkey and made things interesting in the death cell,” it joked.
Uncharacteristically quiet in the face of personal attacks, Kinyoun kept to himself at Angel Island, away from the din of a city that he was starting to loathe. He continually checked on the status of the animals in his care, looking for any sign that might calm his nerves despite the evidence of plague bacilli he had found in Wong Chut’s tissue sample. His communication with the outside world consisted mainly of telegrams he sent to Washington, keeping Surgeon General Wyman up to date on the status of his research. Yet, owing to the continued friction between the men, all correspondence traveled through James Gassaway, the surgeon in charge of the Marine Hospital Service in San Francisco.
Wyman rarely responded to Kinyoun by name, maintaining an icy distance which gnawed at his already wounded pride. Rather than traveling out to San Francisco himself, the Surgeon General oversaw the Marine Hospital Service’s response to plague from his perch in Washington. He ordered a lieutenant to board the first train from New Orleans to San Francisco, and, once the man arrived, sent him on a mission up the coast, stopping at every port and inquiring about possible infections.
Kinyoun saw the flurry of telegrams as a sign of a man unwilling or unable to face the backlash of a frightened city in person, and, on a night when he could not sleep, confided to Lizzie that he expected the situation to get worse soon. The day after the quarantine around Chinatown was lifted, Kinyoun awoke to discover his laboratory animals lying dead in their cages. He performed autopsies on each one, finding massive amounts of inflammation and bacilli that he identified as plague.
There was now no doubt in his mind that the disease he most feared was festering in the city, and he suspected that Wong Chut King was not its first victim—nor would he be its last.
CHAPTER 5
FAULT LINES
The confirmation that plague was now in San Francisco was largely ignored by those who desperately wanted it to be otherwise.
Physicians on the Board of Health refused to accept Kinyoun’s findings, fearful that any acknowledgment of the disease would narrow their city’s future. Reporters simply mocked him and amused themselves by implying that he had killed the animals himself out of impatience and greed. The deaths most likely came “as a result of neglect and the emaciation that follows close confinement and too persistent attention from eager bacteriologists,” according to the San Francisco Chronicle. Other papers ran editorial cartoons depicting Kinyoun’s inoculated animals picking the locks of the city treasury, a particularly stinging rebuke for a man who prided himself on his thrift.
Nor did
Kinyoun find what should have been his natural allies in Washington. In an article published in January, shortly before the discovery of the disease in San Francisco, Wyman had expressed his skepticism that plague would ever pose a significant danger to the United States or Europe. “It seems impossible that the plague should ever again ravage the earth as in previous cities,” Wyman wrote. “Even should the disease spread to certain European countries, modern sanitation of cities, the knowledge of disinfectants and improved disinfecting appliances, and modern knowledge of the disease itself will doubtless enable it to be confined within reasonable limits.” Laboratory work taking place on a far coast done by a man he did not respect enough to utter his name aloud was not going to change Wyman’s mind.
With no authority to reimpose a quarantine and no support, Kinyoun forced himself to stay silent on Angel Island and take the abuse. He felt a duty to act, regardless of how the public felt about him, yet he was frustrated by his lack of options. He had come to believe that advances in the science of bacteriology and immunology would soon render all disease a thing of the past, leaving any death from illness that happened under his watch a heavy stone on his conscience. “The infection of innocent persons, in my mind, is nothing more or less than deliberate or premeditated manslaughter,” he wrote in a letter to a friend. At best, he hoped that Wong Chut King’s death would prove to be an outlier and that the fumigations undertaken during the short-lived quarantine would be enough to prevent a full epidemic. Yet he knew that if the disease continued to spread without a quick response, it would bring the misery now felt in Hong Kong, with its mass graves and abandoned city blocks, to American shores.
