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Plague in the Continental United States, 1900-76

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Plague in the Continental United States, 1900-76 Plague in the Continental United States, 1900-76 ELIZABETH T. ANDERSON, RN, MS BUBONIC PLAGUE, like cancer to- ing. Organisms with characteris- ducted an investigation supported day, was probably one of the most tics of the plague bacillus were by large businesses, the board of dreaded and feared diseases a cen- discovered by Kellogg in smears trade, the chamber of commerce, tury ago, and even today it is of of lymph fluid (5). The Chief and the railroad industry. It was interest (1-3). Is interest today Quarantine Officer at the U.S. Ma- concluded from this investiga- merely of historic note? The fol- rine Hospital Service at Angel tion that plague "Did not nor lowing review of the history of Island, Dr. Joseph Kinyoun, was ever did exist in California" (5). plague in the continental United notified of Kellogg's discovery. The political battle waged over States provides a context for our Kinyoun recommended that ex- the need to quarantine part of current knowledge, points out that posed Chinese of San Francisco San Francisco and to fumigate the the threat of human plague still be inoculated with antipest serum Chinese community has been exists, and alerts public health and that the entire area be fumi- called "One of the sorriest epi- workers in certain areas to this gated. Twelve blocks of China- sodes in American medical his- potential danger. town were surrounded by police tory" (5a). Even before the first case of in search of persons who might By 1904, 118 of 121 persons re- plague was documented in the have the disease. ported to have had plague had United States, Surgeon General However, what might have been died. Kinyoun had resigned from Walter Wyman noted in a pam- a routine investigation of a poten- Federal service. An order from phlet published for the use of his tially major epidemic became a President McKinley to limit travel medical officers (4a): major concern, not only for the of orientals was refused. And the health of the citizens but also new Governor of California recog- The appearance of the plague in for commercial interests. A bitter nized the existence of plague and Santos, Brazil, in October 1899 marks an important epoch in plague literature attack was launched against cooperated fully toward its eradi- as furnishing the very first recorded Kinyoun and the board of health. cation. Rat proofing of buildings instances of the occurrence of the disease Pressure became so intense that had begun, and the outbreak had in the Western Hemisphere. the initial quarantine was lifted ended (6). Shortly thereafter, plague was dis- after only 60 hours. But, by Although the exact method by covered in San Francisco. On March 11 although the bodies of which plague entered San Fran- March 6, 1900, the body of a Chi- the Chinese dead were hidden- cisco is not known, the data avail- nese worker was found in the two more cases of plague were de- able indicate that the population basement of the Globe Hotel and tected in Chinatown (5). transferred to an undertaker. An The newspapers, which had LI Tearsheet requests to Eliza- autopsy revealed large inguinal heretofore refused to print the beth T. Anderson, Assistant Pro- nodes suggestive of plague, and news, could no longer ignore it. fessor, Texas Woman's University, the city physician notified the city Soon the nation knew that plague College of Nursing, 1130 M.D. health officer and bacteriologist existed in California. The Gover- Anderson Blvd., Houston, Tex. Wilfred H. Kellogg of this find- nor of California nevertheless con- 77030. May-June 1978, Vol. 93, No. 3 297 was at risk of an outbreak. Urban sylvatic plague was probably quite breaks of importance." However, plague-plague that is trans- widespread ,(4b): it went on (13a): mitted in a rat-flea-rat cycle with June 18. Two boys died. Had been During the last 20 years [plague] has man as an incidental host-de- shooting squirrels in Contra Costa been traveling to all corners of the pends on a dense rat population County, May 29, 30, 31, . This marks earth, following the commercial routes, which harbors a high flea popula- the 3d or 4th death in the past year to especially water routes. Ships carry rats be apparently associated with ground and rats carry plague, so that in the tion, optimally the oriental rat squirrel infection, and that the squirrels absence of special precautions to prevent flea, Xenopsylla cheopsis (7). The of Contra Costa County are already the introduction of the disease in this rat population must have infected seem to be foregone conclu- way it would be suprising and quite dense sions. These animals infest the whole accidental if ports of any size have existed in Chinatown because the state, their burrows being a continuous escaped the infection. poor sanitation there has been chain from one end to the other. well documented. The plague Sporadic cases of human plague How prophetic these words bacillus most likely was intro- of sylvatic origin were reported might have seemed to the people duced by ships from the Orient. from Seattle to southern Cali- of the Gulf Coast had they seen Bubonic plague was pro- fornia, giving some hint of the them 5 years later when human nounced "eradicated" in 1904 pri- extent of infection in the rodent plague was recognized nearly si- marily because of three factors: population during the early 1900s. multaneously in Galveston, Beau- (a) bitter opposition to continu- Annual reports of the Surgeon mont, and Pensacola,(14). Closely ing eradication efforts that hurt General reflected concern over following these outbreaks, cases business and trade, (b) an absence this newly discovered locus of were also reported from New of new cases in man, and .(c) in- plague. Regular notations were Orleans and Port Arthur; a total adequate epidemiologic informa- made of numbers of rodents (rats, of 71 cases with 31 deaths resulted tion (8). If the rat population had squirrels, and others) found and from these outbreaks. been surveyed at the time, how- inspected, as well as the numbers Shortly thereafter, yet another ever, it would have been evident infected. epidemic was in progress. Again, that the disease had not been This concern was well founded. plague pneumonia was the major eradicated. After the 1906 earth- On August 15, 1919, after hunting killer. A 2-week outbreak in Octo- quake followed by fire in San in the Berkeley Hills and bring- ber and November 1924 occurred Francisco, "Rubbish, garbage, and ing home a squirrel, a man con- in the primarily Mexican section human and animal wastes piled tracted plague and subsequently of Los Angeles. Of 39 human cases high. Rats multiplied and fat- died. This case is of particular reported, 28 were in Mexicans; tened in the filth, and passed their note for several reasons: (a) the a total of 33 persons died. The fleas on to the ground squirrels man developed secondary plague epidemic was contained, accord- in the rural areas" (4b). From pneumonia (the major form in ing to Wayson ,(15) who compared May 30, 1907 to June 30, 1908, which plague can be transmitted it with the earlier epidemic in San 159 cases of plague and 77 deaths from man to man), ,(b) this was Francisco's Chinatown, because were reported (4c). the "first instance of an epidemic the Mexicans were "easier to deal Between 1900 and 1908 it was of pneumonic plague on the with" and did not hide their dead. discovered that the ground squir- Western Hemisphere" (12), (c) the Rat proofing of buildings in a rel population of California, as plague was of sylvatic origin, .(d) number of port cities seemed to well as the rat population, was in- of the 13 persons who later con- be paying off in more than a fected with the plague bacillus. tracted plague, 12 died, and (e) the diminution of plague cases. The Two theories concerning the in- manner in which the epidemic Surgeon General's 1917 report from New Orleans pointed out fection of wild rodents, referred to was contained by hospitalization of the as sylvatic plague, prevail: (a) that and isolation is a somewhat classic some "fringe benefits" (13b): they became infected through im- example of containment (12). The average number of fleas per rat from the urban rats and On the heels of the outbreak had lessened; the general health of the portation community was improved; and it is also (b) that plague had existed in the just described, plague was re- estimated by the fire marshall that as wild rodents but had not been ported from yet another area of a result of rat-proofing the number of identified previously (9-11). An the country. The Surgeon Gen- fires had been reduced. entry by Dr. Rupert Blue in the eral's 1914 report stated that there Additionally, Oakland, Calif., was San Francisco plague Journal in was continued world prevalence declared "free from plague infec- 1904 attests to the possibility that of plague with "no unusual out- tion" in 1925, and restrictions 298 Public Health Reports est, it has been supplanted by an Figure 1. Reported cases of human plague, United States, 1900-75 increasing prevalence of sylvatic plague in the United States. Of the 100 cases of human 150 plague reported since 1950, 22 percent of the 54 males and 13 percent of the 46 females died 100 (fig. 2). Eighty-one percent of the cases occurred in the age group U) a) under 30, reflecting the younger U) 50 0 persons' greater exposure to in- fected animals (fig.
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