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JAMA Revisited
May 19, 2020

The Bubonic Plague in San Francisco

JAMA. 2020;323(19):1978. doi:10.1001/jama.2019.13444

Originally Published May 19, 1900 | JAMA. 1900;34(20):1235- 1237.

We have always regarded the plague as something very distant and impossible, and have read of its ravages in India and China with much the same feeling of composure and security that we read about an uprising of the natives in Madagascar. Or perhaps we have considered it as a matter of historic interest on account of the fearful epidemics which in pre-sanitary days used to sweep over Europe, devastating countries and hardly leaving enough people behind to keep up the archives and records of the state. Even now that it is among us, and in America for the first time, there seems to be a tendency to underrate its importance and dismiss it without a thought, as a scare designed for base political motives.

While I do not believe in becoming unduly excited about it, or in publishing far and wide that there is plague in San Francisco, I do not think that we should try to deny among ourselves the very existence of it, but should accept the situation as it is and do our best to stamp it out while it is still within our power. It would be folly to ignore its presence and allow it to increase to such an extent that the national government would be compelled to step in and take from our hands the work of fighting it and perhaps quarantine the whole city with U. S. troops, thus advertising to the world that San Francisco was not only financially negligent in the face of an epidemic of a disease which is guarded against by the U. S. Marine-Hospital Service with more watchfulness and dread than any other.

San Francisco should look at the history of Oporto, and profit by her experience. The bacteriologist who announced the first case, in January, 1899, narrowly escaped being mobbed. The health authorities were hampered by the merchants and the press, who harped on the injury to trade caused by the announcement of the existence of plague which the laymen, in their infinite wisdom, declared did not exist. The health authorities were refused assistance until finally so many cases appeared that the government stepped in, surrounded the city with a cordon of soldiers, absolutely stopping all travel and business, and it was only after the lapse of one year, and after the experience of a partial famine, that the city was released and declared no longer infected. In the meantime its citizens had parted with the small sum of $7,000,000, a good deal of money, but the probability is that by that time, even the omnipotent and scientifically wise press had arrived at the conclusion that their lives were more valuable than their business.

Just how the disease was introduced into this country is a mystery, as the first case discovered was in a [man] who had been in Chinatown sixteen years. The probability is that he was not the first, and this theory is strengthened by the fact that there had been an increased mortality in that district during the months of January and February. During those months there were 97 deaths reported from [that] quarter, and of these 20 were ascribed to lobar pneumonia, 5 to bronchopneumonia, 4 to typhoid fever, and 7 to acute miliary tuberculosis. Now all of these diseases, in the beginning of an epidemic of plague, should be regarded with suspicion, and examined bacteriologically, for they are simulated very closely by the pest.

The assistant city physician, whose duty it is to inspect all…who have died without attendance by a regular physician, is at a great disadvantage in arriving at the cause of death. He simply sees the body after death, and by questioning the relatives or undertaker…he makes a guess at the cause of death, taking into account the appearance of the body.… Since the plague can readily be mistaken for [other] diseases, we are justified in the suspicion that some of these cases were plague. Nor is the fact that we have not now a wide spread epidemic proof to the contrary, for it has been the history in other parts of the world that the plague gets a foothold very slowly and insidiously. There is a first case, and then it may be a couple of weeks before the second, and they may appear occasionally and at intervals of several days or weeks, until the houses and the quarter become infected, and then the real epidemic breaks out, and hundreds of cases occur.…

Read before the San Francisco County Medical Society by W. H. Kellogg, M.D., City Bacteriologist, San Francisco, Cal.

Section Editor: Jennifer Reiling, Assistant Editor.
Editor’s Note: JAMA Revisited is transcribed verbatim from articles published previously, unless otherwise noted.