As life begins to resume a sense of normalcy, it’s important to reflect upon the lessons learned from the pandemic. Numerous parallels may be drawn to the bubonic plague outbreak of San Francisco at the start of the 20th century. Black Death at the Golden Gate by David K. Randall provides an account of the efforts led by public health officials to combat this disease. Randall is a senior reporter at Reuters who drew upon a wide array of sources, including telegrams and contemporary newspapers, to construct a narrative of the plague. Each chapter provides thorough illustrations of the physicians, scientists, and patients involved, to further draw the reader into the immediacy of the events.
The book begins by outlining a history of the third bubonic plague outbreak, which originated in a Chinese province called Yunnan. At the time, scientists understood that rod-shaped bacteria called Yersinia pestis caused the disease. Following the initial infection, the bacteria would then multiply in the lymph nodes, forming the distinctive buboes found on corpses. The patients finally succumbed to septic shock and organ failure, among other symptoms. However, Randall notes that “antibiotics, which might halt plague 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.” In 1899, the first American cohort of plague cases was found near shipping ports in Honolulu. It was only a matter of time before the disease would be transmitted to the continental US.
David K. Randall is a senior reporter at Reuters. The New York Times best-selling author of Black Death at the Golden Gate, Dreamland and The King and Queen of Malibu, he lives in Montclair, New Jersey http://davidkentrandall.com/
Photo by Jason Roth Photography
As the number of cases continued to increase, personal and political conflicts hampered progress. Joseph Kinyoun, a bacteriologist, had been dispatched by the Marine Hospital Service to San Francisco, which emerged as the site of a new outbreak. After each reported case, Kinyoun would collect samples from corpses and inoculate animals to confirm the infection. However, the Board of Health repeatedly denied his claims, stating that economic decline would be a greater threat to the city. Even the Surgeon General at the time, Walter Wyman, had refused to publish a report about the true status of the disease. After more than a year of thwarted efforts and his reputation sullied, Kinyoun was forced to leave San Francisco. “He was in all respects powerless, unable to take any measures to combat the disease he remained convinced would soon overtake the nation,” states Randall.
His successor was a physician named Rupert Blue, who adopted a far more effective approach. Whereas Kinyoun had paid “an almost fanatical attention to rules,” Blue sought to establish relationships of trust with Chinatown. For this reason, residents were more willing to provide information on the location of corpses, which allowed Blue to identify the connecting factors. After months of initial frustration, he came to infer that the mode of transmission was fleas on rats. He subsequently implemented a systematic rat killing campaign and tested over two million bodies for the presence of plague. Several years later, a smaller outbreak caused by infected squirrels emerged in Los Angeles, indicating that the plague had migrated south. Regardless, he utilized the same rodent-proofing measures and successfully eliminated the disease.
As a medical student, I have gained a deeper appreciation for public health initiatives from this book. Without the intervention of Rupert Blue, the plague would have propagated to other areas of the US, which would have been detrimental during its early years of development. Although this epidemic is not as widely recognized, it presents valuable lessons to be learned. Foremost, systematic testing was crucial at the onset. Information on the infection rate of rats and the number of human victims was needed to gauge the progress of sanitation efforts. Secondly, this period has underscored the importance of establishing public credibility. Both men refused to downplay the significance of the epidemic, even though they were given numerous opportunities to do so. Evidently, they prioritized public welfare above political favors. Ultimately, I hope that future cohorts of physicians will be able to carry these lessons from Black Death at the Golden Gate, as well as the current pandemic, ensuring that we have truly learned from both history and the present.
Grace Xu
Grace Xu is a first-year medical student at Vanderbilt University. She received her BS in biology from Emory University. Her works have been published in CHEST and Ars Medica. She hopes to further incorporate writing and poetry into her medical education.