Plague in the Unites States

The Bubonic Plague’s entrance into the United States though minor in comparision to other nations was made worse by politicians. The history of the Bubonic Plague can best be described by Middle Age scholar Ibn Khaldun, who wrote, “the East and the West was visited by a destructive plague which devastated nations and caused populations to vanish” (Echenberg, 2002, p. 429). In recorded history there have been three Bubonic Plague pandemics. The first occurred in A.D. 542 (Justinian’s Plague) in the Eastern Roman Empire, starting in Egypt and attacking Constantinople killing millions and helping to bring about the destruction of the Empire. The second started in 1347 in Naples and spread throughout Europe in only 4 years in what became know as the Black Death. Estimates have ranged as high as half of Europe and the Middle East died. There has also been plague like epidemics reported in China starting with the Ming-Qing Dynasty, approximately 1590 until the 18^th century. The third pandemic emerged from the Himalayan region and traveled in South China including Hong Kong by 1894. It was from Hong Kong that the disease spread via British steamships and the rats they carried, finally arriving in San Francisco in 1900 (Echenberg, 2002).

The plague is caused by the pathogen Yersinia pestis. The pathogen is carried by fleas (Xenopsylla cheopis) and transmitted when a rodent is bitten. It is known that hundreds of rodents have been know to carry the infected fleas ranging from rats to rabbits. When the infected rodents get close enough to humans and the rodent host dies the fleas will migrate to humans in search of a blood meal. The key to human infection is getting within range of a hungry and infect flea. The death toll of infected humans without receiving antibiotic therapy is at least 60 percent (Echenberg, 2002). The plague in the United States followed a hierarchical effect by starting in port cities like San Francisco, Los Angeles and New Orleans and spreading into Arizona and New Mexico.

The first reported case of Plague in the United States was a Chinese man who was found dead on March 6, 1900. The Yersinia pesits was identified by the City Health Office. The infected lymph node was given to Dr. Joseph Kinyoun, Chief Quarantine of U.S. Marine Hospital Service in San Francisco. Dr. Kinyoun agreed that it was probably plague. This information was taken to the City Board of Health who immediately ordered the surrounding of a 12 block area of Chinatown, which consisted of overcrowded tenements, suffering severe poverty. What followed was a political firestorm against any idea that plague could exist in San Francisco. The attack was lead by the local newspapers and was joined by the governor of California Henry Gage who used terms such as, “plague scare” when speaking of it, fearing the damage it would do to business and tourism. Gage would continue his opposition right up until the time he left office. Another factor that hindered the investigation was the refusal of Chinese leaders to cooperate by hiding the plague infected bodies from authorities. It took until May of 1900 before these Chinese leaders would begin working with the city health authorities. In January 1901 the Secretary of the Treasury appointed a Commission to deal with the outbreak. A program of cleanup, the burning of clothing and bedding, and fumigation with sulfur was begun. By 1905 121 people would become infected with 118 dying (Lipson, 1972), with overall U.S. deaths hitting about 500 (Echenberg, 2002). How many lives could have been saved had politicians allowed health officials to do there job? As with HIV racism and expedience took priority over people’s lives.

Between 1925 and 1965 human cases of the Bubonic plague numbered fewer than two a year. That changed in 1965 when an outbreak occurred in the Navajo Reservation in northwestern New Mexico. Seven people were diagnosed that year with the plague. The number of cases increased with peaks every 5 to 8 years reaching a high of 40 in 1983. Between 1965 and 1989 308 cases of human plague was recorded, mainly in the southwestern United States with most of the infections occurring near the patient’s home including several cases of infected domestic cats. Rodent plague has been reported frequently over the years but with limited human exposure (Barnes, 1990).

In 1979 the City of Albuquerque and the Centers for Disease Control entered into a long term surveillance and control program with the goal of conducting annual surveys of animal and flea populations for evidence of plague activity and the use of Carbayl dusting of fleas to reduce the population within the Sandia Mountains. Another program was started with local residence being asked to report any unusual numbers of sick or dead animals. The study showed a total of 180 plague positives including 21 domestic cats. The result was the “reaffirming the Sandia Mountains as a hyperendemic area” (Barnes, 1990, p.45).

The Bubonic Plague has shown itself to be a resilient pathogen that has survived the millennia always waiting in the wings for the right time to strike again. Three times in recorded history this plague has produced devastation on humanity. Modern medicine has given us the ability to fight the disease with much success. Though we look through a glass darkly, the history of the plague has shown us a possible future. Used in the past as a biological weapon, catapulting corpses over city walls and dropping infected fleas from airplanes, the possibility exists today for such use by terrorists or nations set on destroying an enemy. Like so many other bacterium there has been “recent observation of the presence of multidrug-resistant plasmids, almost identical to those acquired by Y.pestis” (Stenseth, 2008, p.12). The possibility exists for a drug resistant Bubonic plague.

By focusing on the introduction of this killer in the United States I wanted to show that politics have no place in fighting these deadly zoonotics. A future pandemic of a plague like disease is real. History has shown we have not destroyed these menaces but have only kept them at bay.

Lipson, Loren George (1972). Plague in San Francisco in 1900. Annals of Internal Medicine, 77, 303-310.

Echenberg, Myron (2002). Pestis Redux: The Initial Years of the Third Bubonic Plague Pandemic, 1894-1901. Journal of World History, Vol. 13, No. 2, 429-449.

Barnes, Allan M. (1990). Plague in the U.S.: Present and Future. Proceeding of the Fourteenth Vertebrate Pest Conference 1990, University of Nebraska – Lincoln, 43-46. Retrieved from http://digitialcommons.unl.edu/vpc14/5

Gage, Kenneth L. (2000). Cases of Cat-Associated Human Plague in the Western US, 1977-1998, Clinical Infectious Diseases, 30, 893-900.

Ruiz, Alfonso (2000). Emerging Infectious Disease, Vol. 7, No. 3. Retrieved June 20, 2008, from http://www.cdc.gov/ncidod/eid/vol7no3_supp/ruiz.htm

Stenseth, Nils Chr. (2008). Plague: Past, Present and Future, PLoS Medicine, Vol. 5, No.1, e3