Medicine and Disease in History: Bubonic Plague


Rat Collecting Station. Shortly after 1900. Philadelphia. 

By Alex Gregory

Note: Essay 1 in a series, all from Dr. Amanda McVety’s Spring 2019 class on Medicine and Disease in Modern Society

The bubonic plague ravaged Asia and Europe during the 14th century and resulted in major economic and social paradigm shifts. Fear and a poor understanding about how the disease was spread resulted in epidemics occurring for the next five centuries. The invention of faster transportation, increased levels of immigration, and worldwide trading lead to a fifty-one-year outbreak of the Bubonic Plague throughout the world. Particularly in port cities, such as San Francisco, New Orleans, and Honolulu, the plague proved to be a dangerous and isolating experience for the population. Denial, racial tensions, and attempts at quarantine from the outbreaks between 1901-1910 affected the social understanding and regulations that were implemented around the bubonic plague. Throughout the 1920s and 1930s the scientific understanding of the bubonic plague developed, with the discovery of Bacillus pestis and a link being drawn between historical black death and the outbreaks in the 19th and 20th centuries.

During the 1930s it was understood that the bacteria that cause the plague was Bacillus pestis, but the ways in which the disease entered the body were still being debated[1]. Known as a disease of rats[2], the bubonic plague was thought to contaminate food and water, which would be appropriate with the limited knowledge of how bacteria and viruses were spread in the early 20th century[3]. With the adoption of germ theory and the discovery of Bacillus pestis, it is now known that plague is spread through bodily fluids and vectors, such as fleas, rats, and other small rodents. The 1900-1924 outbreak in India and China allowed scientist to diagnose the Black Death of the medieval period[4], and give reasons behind a long history of fear and death. With the lack of knowledge that preceded the Chinese and Indian outbreaks, several government laboratories were established in these countries, and lead to bacteriologists discovering essential information about the plague[5]. Even though the plague was almost nonexistent during the 1930s in the United States, the history of massive graves and quick deaths allowed fear to persist and lead to the plague still being on the report list for the City of New York.

Today’s understanding of the Bubonic Plague divides the illness into three categories: bubonic, septicemic, and pneumonic. Bubonic is the most common, with approximately ¾ of all cases from the 1900-1924 Chinese/Indian outbreaks falling into this category[6]. Septicemic and pneumonic forms of plague are the deadliest and have the most serious side effects. Septicemic is a form of plague which infects the blood stream and causes death within 24-72 hours. Pneumonic plague can spread directly, quickly, and efficiently from one individual to another, through coughing and other bodily fluids[7]. Early 20th century societies knew that the plague was common among small mammals, but now it is understood to be difficult to eradicate because of its ability to survive indefinitely in its host and the wild population inability to be inoculated[8].

Outbreaks that occurred between 1900-1924 in California[9] gave rise to racism and anti-immigrant attitudes, which carried on into the 1930s and 40s. Today it is known that the plague arrived on a steam ship from Hong Kong and was carried by the rats on board, but those in the United States blamed the Chinese immigrants for bringing the disease to North America. Japanese internment camps during World War II were preceded by the quarantining and unfair treatment of the Chinese during the plague outbreak. Immigrants, the homeless, and those in the lower class were the primary sufferers of the plague, and the denial of San Francisco’s Mayor did not assist in reducing the plague or helping those who suffered. These outbreaks also revealed the staggering differences between the upper and lower classes access to public health initiatives and how indifference of the upper class can cause devastation in the lower class. Even after the surgeon general of the US Public Health Service attempted to implement anti-plague regulations, there was a concern of causing alarm about the disease.

Common preventative measures included rodent control, incineration, isolation, and inoculation. Incineration was a highly used method in Honolulu, resulting in approximately 171,950 dollars of compensation being paid out to insurance companies in 1926 by the U.S government, from the fire suppression methods that were used during the 1899-1900 outbreak of plague[10]. An attempt at quarantining Chinatown grew from the racism and anti-Chinese sentiments that were common during the time. Immigrants were forced to stay in Chinatown, while white individuals could move freely throughout the city. Although rodent control had the ability to be the most effective method of containment, the disinfection campaigns failed in the immediate eradication of the disease. By pouring carbolic acid into the sewers in an attempt to kill the bacteria, the rats fled and began to live among the homeless and those in poor living conditions[11]. Because of the disinfection campaign’s failure, lower classes became even more impacted by the disease, since rodents were the primary carriers of plague. In the late 19th century a plague vaccine was created, but the effectiveness has never been fully studied[12]. In the United States there is not a current plague vaccine accepted by the government.

Hawaii is the only state in the United States to have plague in human victims during the 1930s. Between 1931-1932 there were five instances of plague on the island of Maui, with four of the victims dying; following these cases there was instance of plague in humans in the United States thru the 1930s[13]. During the 1930s there were countless occurrences of rats and small rodents being infected by the plague[14]. Various maps included in the United States Health Service report of 1936 reveal the extent of infected rats across three Hawaiian Islands. The cases are concentrated around waterways and main roads[15], leading to the belief that the plague was being spread through the transportation vehicles that were used. Rats, fleas, or other small mammals would have been stowaways on these vehicles, allowing the disease to spread to other populations.

Although the disease had similar symptoms to past epidemics: high fevers, convulsions, vomiting, pain in the limbs, and appearance of buboes, the social experience of having the disease changed. Attempts at Cartoons, newspapers, and caricatures were used to target the Chinese and other immigrants[16]. Written in Chinese, a poster showing a Chinese immigrant injecting ‘common sense serum’ into a government officials head[17] reveals that the methods being implemented by the government, or white man, were clearly not effective. It is also understood from this image that the targeted groups, particularly the Chinese, were not passive bystanders in this hazardous environment of illness, racism, and denial. By showing how the lower-class citizens understood what was happening to them and around them, the artist of this poster makes a statement about the poor and ignorant treatment of the immigrant population. “Plague phobia”[18] resulted in other illnesses being left untreated, such as appendicitis, because of the fear that the plague would spread if contact occurred between the sick and the healthy. Some individuals claimed that the plague was a “distant, tropical, exotic disease”[19] that should not be worried about, which was a sharp contrast to those individuals who compared the disease to Bolshevism[20]. Having these highly variable views of the plague is a result of the denial and coverups that occurred in California in the early 20th century.

Most diseases come with social, economic, or scientific influences, but the racial tensions left by the bubonic plague were evident for decades and impacted the experience of Asian-Americans/ Asian-immigrants during World War II. Lack of understanding about how the disease was spread lead to blaming the outbreaks on a specific racial group, the Chinese. Even though the plague was not an active epidemic in 1930s, the fear of past epidemics resulted in mandatory reporting and extreme measures to be taken if a case was to appear.

Alex Gregory is double majoring in English Literature and History with double minors in Archaeology and Museum Studies. A native of Liberty Twp., Ohio, she hopes to attend graduate school and study public history or museum studies. 

Bibliography

Chase, Marilyn. The Barbary Plague: The Black Death in Victorian San Francisco. New York:            Random House, 2003.

U.S. Congress, Senate, Committee on the District of Columbia. Experiments on Living Dogs. Washington, DC: GPO, 1930

Bollet, Alfred. Plagues and Poxes: The Impact of Human History on Epidemic Disease. New York:           Demos Medical Publishing Inc., 2004

Herlihy, David. The Black Death and the Transformation of the West. Cambridge, Ma: Harvard        University Press, 1997.

California State Board of Health. Ground Squirrel Eradication. Sacramento, California, 1911

Center for Disease Control. “Plague Vaccine,” CDC.org              https://www.cdc.gov/mmwr/preview/mmwrhtml/00041848.htm. (accessed March 2,     2019).

The United States Public Health Service, United States Treasury Department. Public Health     Reports. Washington, DC, 1936. Pp 1537

Kellogg, Williams and Simpson (1920). Present Status of Plague. American Journal of Public   Health, 11, p.844.

U.S Congress, House, Special Committee to Investigate Communist Activities in the United           States. Investigation of Communist Propaganda. Chicago, Il., 1930.


[1] Marilyn Chase, The Barbary Plague: The Black Death in Victorian San Francisco (New York: Random House, 2003), 44

[2] U.S Congress, Senate, Committee on the District of Columbia, Experiments on Living Dogs (Washington, DC: GPO, 1930), 174

[3] Alfred Bollet, Plagues and Poxes: The Impact of Human History on Epidemic Disease (New York: Demos Medical Publishing Inc.: 2004), 25

[4] David Herlihy, The Black Death and the Transformation of the West (Cambridge, Ma: Harvard University Press, 1997), 20

[5] California State Board of Health, Ground Squirrel Eradication, (Sacramento, California: 1911), 513

[6] David Herlihy, The Black Death and the Transformation of the West (Cambridge, Ma: Harvard University Press, 1997), 21

[7] David Herlihy, The Black Death and the Transformation of the West (Cambridge, Ma: Harvard University Press, 1997), 21

[8] David Herlihy, The Black Death and the Transformation of the West (Cambridge, Ma: Harvard University Press, 1997), 21

[9] Alfred Bollet, Plagues and Poxes: The Impact of Human History on Epidemic Disease (New York: Demos Medical Publishing Inc.: 2004), 25

[10] U.S Congress, Senate, Committee on the District of Columbia, Experiments on Living Dogs (Washington, DC: GPO, 1930), 174

[11] Alfred Bollet, Plagues and Poxes: The Impact of Human History on Epidemic Disease (New York: Demos Medical Publishing Inc.: 2004), 25

[12] Center for Disease Control, “Plague Vaccine,” CDC.org  https://www.cdc.gov/mmwr/preview/mmwrhtml/00041848.htm, (accessed March 2, 2019)

[13] The United States Public Health Service, United States Treasury Department, Public Health Reports (Washington, DC: 1936), 1537

[14] The United States Public Health Service, United States Treasury Department, Public Health Reports (Washington, DC: 1936), 1537

[15] The United States Public Health Service, United States Treasury Department, Public Health Reports (Washington, DC: 1936), 1537

[16] Marilyn Chase, The Barbary Plague: The Black Death in Victorian San Francisco (New York: Random House, 2003), 46

[17] Dr. Kellogg, Dr. Williams, and Dr. Simpson, “Present Status of Plague,” American Journal of Public Health 11 (1920): 844

[18] Marilyn Chase, The Barbary Plague: The Black Death in Victorian San Francisco (New York: Random House, 2003), 50-51

[19] U.S Congress, Senate, Committee on the District of Columbia, Experiments on Living Dogs (Washington, DC: GPO, 1930), 174

[20] U.S Congress, House, Special Committee to Investigate Communist Activities in the United States, Investigation of Communist Propaganda (Chicago, Illinois: 1930), 89

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