A generation after it was eradicated in the United States, measles is once again spreading across the country, where since the start of the year more than 550 cases have been confirmed in 20 states. An outbreak of the disease in New York City prompted Mayor Bill de Blasio to declare a public health emergency on April 9, and call for mandatory vaccinations in two neighborhoods of Brooklyn, where it has become clustered in the Hasidic and Orthodox Jewish communities.
As I’ve followed the course of the outbreak, I keep finding parallels to the country’s often-forgotten fight against the most fearsome disease of them all: bubonic plague. What began as an isolated case in San Francisco soon turned into a national emergency that threatened millions of lives, forcing public health officials into making hard choices they could not easily undo. As the crisis deepened, it soon became clear that the personalities of the doctors in charge of containing the disease — and not just their understanding of science — would determine the fate of the country.
In March of 1900, a Chinese immigrant by the name of Wong Chut King became the first known victim of bubonic plague in North America, having likely contracted the disease from rat fleas that reached San Francisco aboard a ship bound from Honolulu. Fearing an outbreak that had left more than 10 million dead in China and India in a span of less than five years, panicked officials at the city’s Board of Health ordered police officers to string ropes around the borders of Chinatown and place the neighborhood under quarantine the night that Wong’s body was discovered, effectively sealing a fifth of the population of San Francisco into a warren of 12 narrow blocks. The order was lifted by the city’s mayor after two days, but not before the social damage had been done.
Rupert Blue had barely graduated from medical school and was nobody’s idea of a genius.
Given the outspoken bigotry of elected officials in the city at the time, Chinese immigrants already had reason enough to distrust outsiders. The hasty quarantine seemed to feed into those suspicions, prompting local leaders to start to hide likely plague victims and undermine any attempt to contain the disease even as it continued to spread through the neighborhood unchecked. As the death toll rose to over 100, a public health officer by the name of Joseph Kinyoun — then considered one of the nation’s most brilliant doctors — resorted to increasingly draconian measures, including mandatory doses of an experimental vaccine, in an attempt to force the residents of Chinatown to protect themselves from the disease. His top-down efforts were mocked in the local press and ineffective among the community in the greatest danger of contracting plague, which began referring to him as the “wolf doctor” for his aggressiveness. Soon after he briefly quarantined the entire state of California in a desperate attempt to prevent the disease from spreading toward the major cities of the East Coast by rail, he was unceremoniously transferred to Michigan, but not before a state legislator introduced a bill calling for his hanging.
His successor, Rupert Blue, had barely graduated from medical school and was nobody’s idea of a genius. Yet he was ultimately able to succeed where the better qualified Kinyoun had failed by drawing on his greatest strength: affability. From the moment he stepped into San Francisco, all of Blue’s major decisions were pointed in the direction of building social bonds with those who were in the path of the plague rather than resorting to the humiliating and dangerous practice of quarantine. Where Kinyoun remained clustered at a research station on the distant Angel Island, Blue opened an office off Portsmouth Square in Chinatown; when Kinyoun would only meet with local Chinese officials with the protection of a police escort, Blue made a habit of strolling through the neighborhood with just a translator at his side. Soon, this bottoms-up approach had results: local residents not only began informing him of suspected cases before they could be covered up, but trusted that his efforts to improve the appalling living conditions in the neighborhood’s tenements was not a smokescreen to ready it for white gentrification, but would stall the disease by eliminating the rats that helped spread it. With community support behind Blue’s then-radical notion to target rats to starve plague of new victims, Chinatown was soon not only free of plague, but was considered one of the cleanest neighborhoods in the city.
Blue’s focus on the twin goods of sanitation and sociability again saved San Francisco following the 1906 earthquake, which leveled vast stretches of the city and sent plague-bearing rats through camps holding tens of thousands of refugees in parks from the Sunset District to the Embarcadero. With pneumonic plague — the most virulent form of the disease, which can be spread by coughing alone — threatening to devastate San Francisco as it had Hong Kong before it, Blue launched a citywide campaign against rats, going so far as to pay a quarter for every rodent brought into a sanitation office he called the Rattery. At the same time, Blue and his assistants appeared at every community organization that would have them, preaching the gospel of rat eradication in front of audiences ranging from longshoremen to women’s clubs. By the time the disease was officially eradicated from San Francisco in 1909, more than two million rats had been killed in the city, a sum more than five times greater than its human population. Blue, then considered a national hero, tackled plague scares in New Orleans, New York, Philadelphia, and Los Angeles over the following decades, saving millions of lives through his relentless efforts at making local communities his partners in the art and science of destroying rats.
Measles is not the plague, of course, and cities are far more sanitary now than they were even at the end of Blue’s cleanup efforts. But in his single-minded effort at putting a human face on the abstract idea of public health, Blue helped break down the social barriers that can allow disease to spread despite the fact that effective treatments and methods of prevention have been established. New York’s decision to declare a public health emergency may help curtail measles in the short run, but finding ways to follow more closely in Blue’s footsteps may be what prevents an outbreak that claims lives unnecessarily.
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David K. Randall
is a senior reporter at Reuters
. The New York Times
bestselling author of Black Death at the Golden Gate, Dreamland
, and The King and Queen of Malibu
, he lives in Montclair, New Jersey.