- - Thursday, October 30, 2014

ANALYSIS/OPINION:

If Americans suspected of carrying the Ebola virus are upset about federal and state quarantine regulations and threaten court action, it brings to mind a situation that existed in San Francisco from 1900 to 1904 when bubonic plague cases arose in the city’s Chinatown. Public health officials were quick to quarantine the area’s residents and urge inoculation with a largely untested vaccine.

The dilemma was heightened by a lack of medical knowledge about the disease, usually fatal within three to five days, and characterized by initial symptoms of high fever, lethargy and headache followed by enormous swelling of lymph nodes, especially in the groin area, coma and death. Conventional wisdom, held by U. S. Surgeon General Walter Wyman, was that the disease was airborne and contagious, harbored by unsanitary living conditions. The excrement of infected rats, Wyman believed, could produce the malady. In reality, the plague was spread by the bites of fleas from infected rats and was not infectious.

After only one death on March 6, 1900, the full power of the city’s health board was unleashed on Chinatown’s population, including quarantining with ropes and policemen as well as a house-to-house inspection and cleaning with strong disinfectants. To be sure, quarantining was sanctioned by federal law as early as 1798, and cities with ports followed suit. However, the strategy was employed on passengers from incoming vessels. Never before had an entire section of a city been cordoned off.

Some state officials, such as California Gov. Henry Gage, were correct in believing that the disease was not infectious and were especially concerned that the state’s economy would be hard-hit by inaccurate information. Bad news traveled fast, though, and ultimately Colorado, Texas, and Louisiana imposed a quarantine on California goods. Given the panic that ensued, Gage was denied re-election in 1902.

The quarantine was lifted within three days because of opposition by Chinatown residents and some community leaders. Then when four more deaths from the disease were recorded in mid-May. public health officials, led by Wyman, took to inoculation with an experimental and highly toxic drug. A force of inoculators invaded Chinatown on May 19, urging that residents undergo the immunization procedure. Few, however, did, so officials turned to the legal maneuver of requiring a certificate of inoculation before Chinese residents could travel on any railroad. Within days, a suit was filed in federal court on the grounds that these tactics were unconstitutional. In a case titled Wong Wai v. Williamson, the court quickly agreed in a decision handed down on May 28.

The health board was not about to let the matter rest. On May 31, it devised its second quarantine of Chinatown and contemplated even stronger measures in the event that more cases were detected, including building a wall around the area or even removing residents to areas outside San Francisco. The board paid no heed to the need to ensure that the quarantined Chinese would be provided with food, medicine and other necessary supplies. Within days a Chinese grocer, Jew Ho, filed suit in the same federal court that had granted relief from the inoculation requirements. The court, as in the earlier case, acted with dispatch, declaring the law discriminatory and therefore unconstitutional.

Still, Chinatown residents had one additional problem to deal with. A federal health officer under Wyman devised regulations requiring anyone wishing to leave San Francisco for out-of-state destinations had to undergo examination in federal hospitals to ensure that he was not infected with the disease. Again, an uproar ensued — so much so that the matter reached President William McKinley, who put an end to the practice.

Scattered cases of the plague continued for the next four years, with a grand total of 121 cases and 113 deaths. Fortunately, another federal health officer, Rupert Blue, who would later become surgeon general and president of the American Medical Association, played a critical role in defusing the disease. He campaigned for a war against rats, using federal tax dollars to pay citizens 10 cents for each rat killed and deposited with authorities.

Thomas V. DiBacco is professor emeritus at American University.

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