Distillations podcast

Deep Dives into Science Stories, Both Serious and Eccentric
April 4, 2023 Health & Medicine

‘That Rotten Spot’

When the plague struck San Francisco in 1900, public health officials blamed Chinatown, as if the disease itself had a racial component.

Graphic of Golden Gate Bridge and Asian market

When the plague broke out in San Francisco in 1900, the public health department poured all of its energy into stopping the spread of the deadly disease in Chinatown—as if Chinatown were the problem. This episode reveals why they did it, what it has to do with race science, and what it tells us about the history of public health.

About Innate: How Science Invented the Myth of Race

“That Rotten Spot” is Episode 8 of Innate: How Science Invented the Myth of Race a podcast and magazine project that explores the historical roots and persistent legacies of racism in American science and medicine. Published through Distillations, the Science History Institute’s highly acclaimed digital content platform, the project examines the scientific origins of support for racist theories, practices, and policies. Innate is made possible in part by the National Endowment for the Humanities: Democracy demands wisdom.


Hosts: Alexis Pedrick and Elisabeth Berry Drago
Senior Producer: Mariel Carr
Producer: Rigoberto Hernandez
Associate Producer: Padmini Raghunath
Audio Engineer: Jonathan Pfeffer
“Innate Theme” composed by Jonathan Pfeffer. Additional music by Blue Dot Sessions

Resource List

Bitter Roots: Five Generations of a Chinese Family in America , by Bruce Quan, Jr.

Black Death at the Golden Gate: The Race to Save America from the Bubonic Plague, by David K. Randall

Translating Western Modernity: the first Chinese hospital in America, by Guenter B. Risse

Plague at the Golden Gate, documentary film.


Lisa Berry Drago: Welcome to Distillations. I’m Lisa Berry Drago. And this is Innate: How Science Invented the Myth of Race, episode eight, That Rotten Spot. This is a story about a global pandemic. You’ll hear about one turbulent year, a disease-infected ship, a quarantine, a mass vaccination campaign. It all may sound familiar, but no, this is not about 2020 or about COVID. This episode is about the year 1900. The world’s third bubonic plague outbreak is raging, and it makes its way to the shores of San Francisco. When the plague broke out in San Francisco in 1900, the Public Health Department laser-focused on Chinatown, as if Chinese people were the source for the problem.

Lisa Berry Drago: I’m gonna hand the story off now to Padmini Raghunath, our Oakland, California-based producer. Chapter one, Honolulu Burning.

Padmini Raghunath: So, it’s the turn of the 20th century, and an old enemy has come back, the plague. It started in South Central China in the late 1860s. This was the third wave. The first was the Black Death in Europe during the Middle Ages. The second was also in Europe 200 years later. And by the 1890s, the third wave had peaked. It had just killed tens of thousands of people in Hong Kong.

Padmini Raghunath: The U.S. Marine Hospital Service, the precursor to the Public Health Service, is tracking the return of the plague. They fully expect the disease to invade the U.S., and soon. They’re watching it hit port cities, bearing down along the Pacific Rim, Bombay, Hong Kong, Sydney, leaving millions dead in its wake. And then, it strikes Honolulu.

Lisa Berry Drago: January 20, 1900, the skies above O’ahu were black with smoke. Bubonic plague had been discovered in Honolulu’s Chinatown, and panicked health officials were doing everything they could to try to stop the spread.

Padmini Raghunath: This is from the PBS documentary, Plague at the Golden Gate. People thought the plague had arrived on a steamship from China.

Speaker 3: On the morning of a December day in 1899, a man woke up with a high fever and mysterious swelling throughout his body.

Padmini Raghunath: This is from a Hawaiian local news segment about the plague outbreak of 1900.

Speaker 4: The victim died a few days later, where then an autopsy took place confirming that, for the first time in history, the bubonic plague had reached Hawaii.

Padmini Raghunath: And a few Chinese residents there die. Public health officials decided to quarantine the whole Chinese quarter, which is also home to Japanese and Native Hawaiian residents.

Speaker 4: Eight city blocks of Chinatown went under lockdown, trapping more than 10,000 men and women. Lines drawn on the roadways, armed with soldiers fixed with bayonets distinguish the boundaries.

Padmini Raghunath: A German teenager named Ethel Johnson develops a high fever. Her house was just outside the quarantine zone. Soldiers posted up outside her family’s house, preventing anyone from entering or leaving. Board of Health doctors thought this was insulting, because she was being lumped in with, as they put it, Hawaiians, Japanese, and Chinese, an act which would defile the dignity of her whiteness, the people who control and rule this archipelago. She died five days later. The city’s elite doctors and public health officials got together and decided that they had to take more drastic measures. They would burn every house in Chinatown they suspected of harboring plague victims.

Padmini Raghunath: The winds change and the fire spreads quickly. The neighborhood erupts into flames. And a white mob forms around the boundary of Chinatown, attacking Asian people who try to escape. The mob was trying to keep the plague in Chinatown at all costs. Desperate families are faced with an impossible decision, burning, bludgeoning, or getting shot by the mob. Finally, by mid-afternoon, the military creates a single exit for the panic-stricken people.

Lisa Berry Drago: The fires burned for 17 days and left nearly all of Chinatown in ashes. 4,500 of its residents were homeless.

Padmini Raghunath: They were taken to the grounds of a church nearby, where they were given tents and blankets. Health officials would soon move them to camps away from the city center, where they would be made to shower daily in front of doctors who believed they harbored disease. It’s one of the most gruesome racist chapters in the history of public health. But issuing quarantines for just the Chinese quarter and seizing and burning their belongings, that actually wasn’t so uncommon at the time. In this episode, we’re going to answer this question, why did public health officials target Chinatowns and specifically Chinese people when disease broke out? What was the race-based thinking that led to some of the most Draconian policies from public health officials at this time? And how did the Chinese resist? The plague wouldn’t stay in Honolulu. It would travel across the Pacific to the San Francisco Bay.

Lisa Berry Drago: Chapter two, Angel Island.

Padmini Raghunath: In June of 1899, six months before Honolulu Chinatown burned, a ship called the Nippon Maru entered the San Francisco Bay. As it approached Angel Island, a ragged little outpost right near San Francisco sailors raised a yellow quarantine flag. There were sick passengers on board.

Casey Lee Dexter: So, there’s only four buildings left from the quarantine era on Angel Island, out of 40, 50 buildings that were here at the peak.

Padmini Raghunath: I’m with Casey Lee Dexter, the state park interpreter for Angel Island. It’s the largest island in the San Francisco Bay, and only accessible by ferry. At the turn of the century, Angel Island served as a quarantine station for ships passing into the United States. And by 1920, it would be the port of entry for every immigrant to the U.S. by way of California, basically an immigrant detention center run by health officials. It was here that Joseph Kinyoun, a doctor and the highest-ranking West Coast official for the Marine Hospital Service, received passengers from the Nippon Maru for inspection and quarantine.

Casey Lee Dexter: Right, there’s, there’s in part so many buildings at the quarantine station because there’s these different levels of quarantine. There’s [inaudible 00:06:57].

Padmini Raghunath: Buildings for the not exposed, the likely exposed, and the ones exhibiting symptoms.

Casey Lee Dexter: So, they had a Chinese barracks, a Japanese barracks, and they also had barracks based on the class that you were traveling in. So, cabin passengers are first class, second class, and steerage.

Padmini Raghunath: The Nippon Maru was infamous. It had set sail from Hong Kong, but had been forced to quarantine both in Yokohama, Japan, and Honolulu after several of its passengers died from what seemed like the plague. Almost all the bodies had been buried at sea, but they still had one corpse from a Chinese passenger. While the workers cleaned the ship, Joseph Kinyoun took tissue samples from the Chinese man to his lab.

Casey Lee Dexter: [inaudible 00:07:43]?

Padmini Raghunath: Yeah, [inaudible 00:07:44].

Padmini Raghunath: Casey and I walk up to a big stately house.

Padmini Raghunath: And this would have been where Kinyoun lived right?

Casey Lee Dexter: Yes, Kinyoun would have lived here, and as well as, you know, the [inaudible 00:07:54].

Padmini Raghunath: The wraparound porch is patchy in places, but through the large dusty windows, we can still see its grand fireplaces and wood inlay.

Padmini Raghunath: It’s kind of… I mean, it’s interesting because it seems like, from the historical accounts, Kinyoun just like was it like a huge people person, just kind of imagining him holed up out here [laughing]. While there’s a plague happening, it’s almost… it feels like, I don’t know, like so isolated.

Casey Lee Dexter: It is very isolated.

Padmini Raghunath: And can you determine from his lab test that the Chinese men from the ship did not have the plague? The remaining passengers got released.

Lisa Berry Drago: Chapter three, the Paris of the West.

Padmini Raghunath: While Joseph Kinyoun was at his outpost on Angel Islan[laughs]d preparing for the worst, San Francisco was in the midst of celebrating a new century.

Speaker 6: San Francisco in 1900, it was a city coming of age, wealthy, cosmopolitan. It was on the brink of fulfilling its destiny as the Paris of the Pacific. The view-down market stream revealed a bustling city filled with horseless carriages, cable cars, and sophisticated men and women wearing the latest fashions.

Padmini Raghunath: And a man named Lu Hang wanted a piece of it. He was originally from Southern China. But by 1900, he’d spent almost three decades in the most splendid city on the West Coast.

Padmini Raghunath: Could you describe the picture?

Bruce QuanBruce Kuan: Yeah, the picture is of my great-grandfather who was the first Chinese person to own a car. That’s his car in the background.

Padmini Raghunath: I’m sitting next to Bruce Kuan, Lu Hang’s great-grandson. We’re right at his home in Oakland, right across San Francisco Bay. Bruce’s family has been in the Bay Area for five generations.

Padmini Raghunath: He’s perfectly dressed.

Bruce Quan: Yes, very much. Oh, that’s the… and that’s the bodyguard.

Padmini Raghunath: Oh, wow.

Bruce Quan: He always traveled with a bodyguard.

Padmini Raghunath: Lu Hang spent his childhood in Hong Kong in the mid-1800s, during what’s called the century of humiliation by the Chinese government.

Bruce Quan: Let me see if I can set the stage for you. In the mid, uh, 19th century, the southern part of China was beset with a drought, the Taiping Rebellion, and also the western countries were dividing up China. On top of that, you also had areas in China which were not able to support agriculturally the populations. So, you had this diaspora that came out of what they call the province of Long Jiao.

Padmini Raghunath: And they went all over the world. Lu Hang’s parents sent him to San Francisco to join his brother who owned a dry goods store, and had been sending money back to his family for years. Lu’s father warned him about how he might be treated in the U.S. He himself had gone a few decades earlier during the gold rush.

Bruce Quan: And once he was here and went into the Gold Country, he found that it was not amenable for Chinese to be there. And in my book, I wrote about, uh, the folklore that had been carried out for generations about my great, great-grandfather having witnessed the shooting by drunk white miners of the Chinese. He feared for his life, came back to San Francisco, went into Chinatown. And there was no place to stay, except with the rats and the cockroaches, and, uh, then camped out along the shores of San Francisco until he had just enough money to go back to China.

Padmini Raghunath: Despite the warning, Lu Hang went to San Francisco anyway. At his brother’s store there, he took on a lot of tasks. He was the janitor, the errand boy, the bookkeeper. He was ambitious. As a teenager, he made friends with a customs broker named PW Belinggal, who taught him about investments and running a business. And eventually, Lu Hang started a business of his own, the Pacific Fruit Packing Company. He chose an American-sounding name so that he could fly under the radar as a Chinese business owner.

Bruce Quan: My great-grandfather realized that, look, these people don’t care whether you’re, you’re yellow or white, as long as the color is green.

Padmini Raghunath: Lu Hang was able to protect himself from xenophobia with money, but that would only go so far. He was worried that the plague was coming to San Francisco. So, he started preparing.

Bruce Quan: After he apparently understood or read about the Honolulu situation, then he had everybody go through his property, chasing all the rats, whatever they could find. They took the rats down to rat disposal area, so that he would have it on record that he had gone through his place and gotten rid of the rats. Because that was one of the ways that they would then identify a building and say, if there were rats in that building, then we will burn down that building.

Padmini Raghunath: Wait, quick pause for science. In 1900, experts knew that there was some relationship between rats and plague, and they had identified the bacterium that caused the disease, Yersinia pestis. But they didn’t know how these things were connected. We now know how the plague actually spreads. The rats host the fleas. And when the rats die, the fleas look for a new host and, often, more aggressively start to bite humans. When a human is bitten by a flea with the bacterium, it’s transmitted through the bite.

Padmini Raghunath: Okay, back to the story. Beyond collecting rats, Lu Hang was thinking through other strategies to protect his business. During our conversation, Bruce pulled out a three-ring binder full of family photos, clippings from the paper, and documents. He slipped five yellowing pieces of paper out from the binder.

Bruce QuanBruce Kuan: So, here’s the… here’s this is what I was talking about. These are the five, these are the five, uh…

Padmini Raghunath: Stock certificates?

Bruce Quan: Stock certificates. See, Lu Hang. Uh, but this is Belinggal. And this man, this is… Yeah.

Padmini Raghunath: During the quarantine in Honolulu, only white businesses had been exempt, even if they fell within the boundaries of Chinatown. Lu Hang knew that the only way he could keep operating would be to make it seem like the Pacific Fruit Packing Company was white-owned. And so, he portioned off the business to four white friends. Effectively, Lu Hang created a white shell company around his business.

Bruce Quan: So, this was what we believe was his way of saying, if we had to present this, saying let the ownership is… resides with, uh, a majority of white people.

Padmini Raghunath: That they should be exempt from [inaudible 00:14:49].

Bruce Quan: Right.

Padmini Raghunath: He was anticipating the worst, and the worst was about to come.

Lisa Berry Drago: Chapter four, Quarantine.

Padmini Raghunath: As the optimism of the new year died down, shopkeepers started noticing rat carcasses littering the streets. The dead rats indicated one thing, that the plague had come to the city. And a 41-year-old lumberyard worker named Wong Cha King had come down with a bad fever. He was exhausted and had painfully swollen lymph nodes. He got traditional Chinese remedies because the city hospitals refused to accept Chinese patients. But those didn’t work. And eventually, he was too sick to even move.

Padmini Raghunath: On March 6th, 1900, Wong Cha King died. When the city physician examined his body, he noticed swollen lymph glands in his groin.

Nayan Shah: He took smears to the glands for further testing. That study aroused suspicions that the man had died upon a plague, but there’s no conclusive evidence.

Padmini Raghunath: This is Nayan Shah. He’s a professor of American studies and history at the University of Southern California. He wrote a book about epidemics and race in San Francisco’s Chinatown. Even though they didn’t know for sure if Wong Cha King had died of the plague, city health officials immediately sprang into action.

Nayan Shah: Later that night, the Board of Health decided unilaterally to do an immediate quarantine of Chinatown. Early the next morning, the city, uh, police dispatched 32 officers to the Chinese quarter to remove… first remove all whites from the affected area, then to cordon it off, and thereafter allowed no one, except for white people, to leave it at no one at all to enter it. So, by noon of the next day, the Chinese quarter was effectively sealed off from the rest of the city.

Padmini Raghunath: When city health officials ordered the quarantine of Chinatown, they were following a common playbook.

Jacob Steere-Williams: The public health plan was one that almost seems very routine for late 19th century public health. Quarantine ships from Honolulu, from Sydney, from Hong Kong, from Kobe, Japan, and a kind of crusade against filth.

Padmini Raghunath: This is Jacob Steere-Williams, a historian of epidemic disease.

Jacob Steere-Williams: This was the central arm of, of Western public health by the late 19th century, remove trash, fumigate sewers, disinfect houses.

Padmini Raghunath: But in order to understand why Chinatown specifically were targeted, it’s important to understand the racial myths about Chinese people that were circulating at this time, and how they were baked into the story California was telling about itself. Down the coast, Los Angeles was still new and underpopulated. And private industry was trying to fix that by rapidly developing it, attempting East Coasters and Midwesterners to move out there. But at some point, they realized they could use some marketing help from the government. And public health officials were instrumental in crafting a narrative. This is Natalia Molina, a historian and author of the book, Fit to be Citizens.

Natalia Molina: You see that from the very first health department report, where the health officer talks about, you know, Los Angeles, it’s, it’s healthy and it’s, you know, got the life-giving sun and the clean air. Ooh, but that rotten spot, Chinatown.

Padmini Raghunath: That place, people have to be careful of. The first wave of Chinese laborers had come to the West Coast to work on the railroads and in the gold mines. But by the 1880s, the railroads were almost done, and there were more workers than jobs.

Natalia Molina: And once the work around, you know, gold mining, around railroads dries up, they’re left to fend for themselves. And they do, and they do so very well. They’re very entrepreneurial. Although, they’re locked out of unions, they’re locked out of so many places of work, they hustle. And they are vegetable peddlers, launders, all these kinds of things.

Padmini Raghunath: During this period of time, there was a lot of attention paid to the Chinese all across the country. The assumption was that Chinese immigrants were mysterious, impenetrable, and definitely unassimilable. Take this quote from a piece in The New York Times describing the Chinese.

Speaker 11: The population was found with all the social vices, with no knowledge or appreciation of free institutions or constitutional liberty, with heathenish souls and heathenish propensities, whose character and habits and modes of thought are firmly fixed by the consolidating influence of ages upon ages.

Padmini Raghunath: When public health officials entered the scene, these assumptions made it easy to attach other labels to them, unhygienic, carriers of disease, and their customs were blamed.

Rana Hogarth: The idea that Chinese people ate rice, like they were referred to as rice-eaters, which was sort of the cultural thing of like you’re doing something different, your diet is different.

Padmini Raghunath: You might remember historian of medicine, Rana Hogarth.

Rana Hogarth: But then, in some ways, people in public health using that as a predisposition for illnesses. Like, they are eaters of rice. They are people who have this custom, and this is what makes them more likely to these kinds of like diseases.

Padmini Raghunath: As Rana and Natalia both point out, it’s a vicious cycle. One of the customs Chinese immigrants were forced into was crowded living conditions. And then, they would be blamed for the spread of disease due to overcrowding.

Rana Hogarth: They aren’t allowed to live in all parts of town. And so, you know, it’s a mainly male population. They’re trying to also live together to save money, but they’re living in overcrowded conditions. And so, then those areas are seen a- as dangerous because they think disease will spread through the air that they breathe. And so, they pass things like the cubic air ordinances.

Padmini Raghunath: The cubic air ordinances were San Francisco laws that required boarding houses to maintain 500 cubic feet of air per resident of the building. The goal of these laws was to create an environment that was so hostile for Chinese workers that they would choose to leave. It was actually anti-Chinese labor activists that had agitated for these laws using health officers reports on the sanitary conditions in Chinatown.

Rana Hogarth: So, the health department is also creating the problems they purport to want to solve. You know, there’s overcrowding. Well, there’s overcrowding, because you’re not letting them live wherever they wish to live. It seems like their business practices are unsanitary, really in the place that you won’t construct a municipal sewer system, you know. So, they’re, they’re constantly policing things that they themselves have instituted. But one of the other things about these zoning ordinances is that they’re also race-neutral, right. So, it’s not like the ordinances are directed to the Chinese launderers. They just so happen to affect all the areas and businesses that they are in.

Padmini Raghunath: The public perception of Chinese immigrants that health officials are winking at, though, are explicitly racist.

Rana Hogarth: So, they’re like cartoons or like advertisements, where it would have a picture, of course, a caricature of a Chinese person. So, a man usually with the queue, punched over an iron that’s spitting. And it would say, “Don’t do this. Go to this laundry.” And it would be like white-owned laundry. So, it’s clear that in, like, communicable disease, like they are trying to really exploit a relationship between these people are sort of people who like trafficking germs and, and filth. And it was clearly mapped onto their cultural and racial identities in, in these advertisements, right? It wasn’t just that this laundry mat is known for unsanitary practices, it was we have to have an image of what we think a Chinese person looks like to do so.

Padmini Raghunath: Getting rid of all dirt, disease, and contagion in the city was not achievable, but confining a problem to one place, Chinatown, and the people in it, was possible.

Rana Hogarth: Chinese people were always seen as a foreign other, like as in how they racially presented, but I think in also the ways in which people assumed that their temperaments and behaviors were kind of innate. There, certainly, were ways in which cultural customs or behaviors, food, practices, whatever became mapped onto a kind of sense of national physique and identity that then became amplified when plague does break out.

Padmini Raghunath: So, the problem is like sediment. The first layer is racist beliefs about Chinese immigrants that goes hand in hand with the anxieties of white laborers. And then come the racist policies that segregate the Chinese. Then come the policies that affect certain “spaces,” which really means certain people. And those policies perpetuate a cycle by making worse the problems they’re claiming to fix. Germs spread in tight quarters. But Chinese people were only allowed to live in one part of the city. When germs spread, health officials doubled down on the idea that it was something innate about Chinese people’s bodies. Their constitutions, that was the problem, not the racism and policing they were being subjected to.

Speaker 13: It’s the public health department that creates certain groups and places as aberrant, that it wants to and needs to and demands to reform to bring them to a certain kind of standard.

Padmini Raghunath: Chinese residents knew this was discriminatory. And they pushed back. They argued in courts that these laws were racially motivated. But they lost many of their cases because the laws never specified race, only place.

Rana Hogarth: They still sided with the side of public health, saying, no, this is not about race. It’s about protecting the public’s health.

Padmini Raghunath: And even when the people who designed the first public health departments on the West Coast left office, they left an indelible mark on the infrastructure.

Rana Hogarth: They have placed clinics in certain parts of town, and not others. They have created policy that reaches out to some immigrants, while not to others. Whether their office or not, those regulations, ordinances are in place. And they’re in place also in the city because their thinking their rationale, their console has now affected city policies, state policies, even national policies and immigration policies.

Padmini Raghunath: Every time there was an outbreak, that association between Chinatown and disease became stronger.

Speaker 13: The idea was perpetuated culturally, and it was participated with and guided by public health officials in particular kinds of ways. The Chinese bring disease. They’re inherent and endemic to it. Somehow, they’re impervious to it. Even if they’re ill, their deaths don’t matter. They’re considered disposable and expendable. Those ideas perpetuate and have a life of their own. And they cycle.

Padmini Raghunath: I’m standing on a bustling corner in San Francisco with Bruce Kuan. We’re on Stockton Street. A buses just emptied, leaving a small mob of people doing their Saturday morning errands to disperse to the nearby Chinese grocery stores.

Bruce Quan: Right in the middle of the block was a Chinese Consulate. And that was 806 Stockton Street. The numbers are all different now. On the corner was the Chinese, uh, mission house. That was 800. 802, 804, 808, and 810 was the Pacific Fruit Packing Company surrounded the consulate.

Padmini Raghunath: So, this is the northern border of Chinatown, right?

Bruce Quan: That’s right. This is where they ran right down the street. They ran the quarantine right down the street.

Padmini Raghunath: Right. So, there would have been like, uh, public health and police officers stationed on this road-

Bruce Quan: Oh, yeah.

Padmini Raghunath: … to beat back any Chinese who tried to [inaudible 00:27:05].

Bruce Quan: Oh, absolutely, absolutely.

Padmini Raghunath: On March 6th, 1900, San Francisco police and public health authorities set up a perimeter around Chinatown. The whole 12-block rectangle and the Chinese people within it were under quarantine orders. If you looked out of Lu Hang’s office window, you would have seen an eight-foot-tall fence topped with barbed wire.

Bruce Quan: It was bounded by California Street, Kearney, Stockton at the top and Pacific on the other side. It was a 12-block area, which at one time house as many as 20,000-plus Chinese because they couldn’t live anywhere else.

Padmini Raghunath: Now, I should mention that there are city health inspectors who impose the immediate quarantine of Chinatown and the federal health officials like Joseph Kinyoun out on Angel Island. It was the city health officials that issued the immediate quarantine. Joseph Kinyoun was skeptical of it, but didn’t suggest repealing it. Instead, he suggested sulfur disinfection treatments in Chinatown and a mass vaccination campaign. But more on that later.

Padmini Raghunath: Anger spread throughout Chinatown. Chinese workers were enraged about the quarantine and mistrustful of the authorities. Basically, everybody’s worst fear was being realized. They had seen what happened in Honolulu. And all signs pointed to a repeat here in San Francisco. The city health officials thought they had made a great call. They had acted swiftly and decisively to contain the outbreak. But they didn’t gamble on what came next, backlash from an unexpected place.

Bruce Quan: They thought they would get enthusiastic support from everyone, because they’re clamping down on the disease right away. Instead, both the city health authorities and the federal colleagues in the public health service faced incredible criticism from politicians and other physicians and newspaper editors and businessmen. The governor of California, Henry Gage, rebuked the city and federal authorities for overreacting, providing widespread national panic. They were concerned that bubonic plague, even the hint of it in San Francisco was going to shut down all transportation, communication, and trade with the rest of the country.

Padmini Raghunath: On March 9th, 1900, just three days later, SF public health officials call off the first quarantine. After the quarantine is lifted, city health officials move forward with some of Kinyoun’s proposals. They disinfect homes with sulfur dioxide and do house-to-house inspections. But these measures were violent. Health officials and police torched belongings in the streets, fumigated buildings, which spoiled goods. And there were rumors spreading throughout Chinatown that health inspectors were beating people and raping them, which solidified their feelings that these measures were just an excuse to be violent towards them.

Padmini Raghunath: And so, reasonably, people would hide their sick friends and family. There were some sporadic suspected cases of the plague through the spring of 1900. One here, through several weeks later, until four suspicious deaths in a row in mid-May of 1900 prompted panic from public health officials again. This time, the city had to seriously reckon with Kinyoun’s second directive, the one I promised I’d get back to, ordering mass inoculation, but only of Asian people.

Lisa Berry Drago: Chapter five, The Old Guard and The New.

Padmini Raghunath: While city public health officials were busy setting up the ill-fated quarantine that lasted only three days, Dr. Joseph Kinyoun was hard at work trying to confirm a plague diagnosis. Dr. Joseph Kinyoun had been a rising star in the maritime health service. But at his core, he was a bench scientist. He loved to be in his lab, examining specimens alone. Kinyoun worked with some of the most renowned bacteriologists in the world.

Padmini Raghunath: He saw lab science and bacteriology as the revelation that would change the world as he knew it, raising the odds on life and health for millions of people. Kinyoun represented the new guard of public health. He was a germ theory guy. Germ theory is the idea that transmissible illnesses are passed on by bacteria and viruses. The city health officials, the ones who opposed the first quarantine, were more old guard. Their work was based on the logic that, if you clean up filth and overcrowding, you control disease.

Rana Hogarth: In the late 19th century and getting into the 20th century, there’s a whole kind of, uh, shift in our understanding of what causes diseases, where people are starting to understand that, even if it doesn’t stink, it could still kill you. Even if it doesn’t look dirty, it can still kill you. People say, oh, this is a great triumph. Again, it’s about science. It’s about isolating the germ. The problem is, is that germs can of course cross the color line. But people are still holding on to a belief that some people are dirtier or backwards than others, and they are the vectors, right, that it’s the people who carry the germs.

Rana Hogarth: So, it kind of shifts it onto the personal responsibility. It’s not like clean up the city or, or the sewers, right? It’s that you person are dirty, and you person are filthy. You person are causing the illness. And if you have that mapped onto an already negative view of a racial group of people, like a racialized group of people, then even with all your scientific wonders, your microscopes, you still end up scapegoating people. You still end up then treating people as the vector, as the cause of the disease.

Padmini Raghunath: And this was exactly what Kinyoun did. Even though he understood how germs worked, he still only considered vaccinating Asian people, rather than the whole city. In his mind, they were still the carriers. He was even considering a plan to forcibly remove all Asian people from their homes and quarantine them in barracks on Angel Island, just like what had happened in Honolulu. The idea that Chinese people and Chinatowns, in general, were havens for filth and poor hygienic practices were already endemic. But those ideas never really went away, even after germ theory was introduced into public health practice.

Rana Hogarth: I think like the biggest disaster like quarantining of Chinatown, of suggesting that if we cordoned off Chinatown, white people can go in and out, but Chinese people can’t, which is, it’s almost as if like they’re armed with germ theory, but they can’t shake the racism. And especially in cases like Chinatown and places where you have crowded living, it’s sort of like saying, oh, people are huddled together. This is the environment they’re in. The germs are in this environment. The germs infect those people. And that’s why they are sick, not that people are… you know, they don’t choose to live that way. They don’t really have a choice.

Padmini Raghunath: Rana Hogarth is talking about an important idea, the concept of vector versus victim. It has bearing on this story, but also other health narratives that still linger today.

Rana Hogarth: Who was the victim, right? Who is the sympathetic victim? Who is the sympathetic face of the disease? And that, I think, is extremely essential to how officials might handle a kind of public health crisis, right? So, when people say, okay, what’s causing it, who is a vector, who’s responsible? When it’s like you are the person, let’s say in cases of minoritized communities, it’s like, okay, it’s your responsibility to not get this and spread it around. It’s like, wait a minute, they’re… aren’t they a victim of the disease? Aren’t they ill? Are they not a patient, a person who needs treatment? So, it’s really… this is also a story, I think, that has a lot to do with public health messaging and how we deploy terminology like a victim versus a vector. And that is extremely embedded in race.

Padmini Raghunath: When four people died between the end of April and the end of May 1900, Kinyoun grew more desperate, he wrote an urgent letter to his boss, Walter Wyman.

Joseph Kinyoun: Examination of plague suspect completed. Diagnosis confirmed by bacteriological examination.

Padmini Raghunath: The next day, he followed up.

Joseph Kinyoun: Regard situation very serious. Will require almost superhuman efforts to control now. So much time has been lost. Over 35,000 people must be controlled.

Padmini Raghunath: He knew that Chinese people in the city did not trust the health authorities and that many of them were hiding their sick. He wrote this in a letter to a friend.

Joseph Kinyoun: How many China men have died from plague, and how many corpses of victims from this disease awaited shipment to China, no white man will ever know.

Padmini Raghunath: And he decided there was only one solution, force every Chinese and Japanese person, every vector, to get a still experimental vaccine, all to protect potential victims.

Lisa Berry Drago: Chapter six, the Haffkine Dose.

Padmini Raghunath: Kinyoun tried to implement a forced inoculation order, but rumors were already circulating. Many Chinese residents had seen the bubonic plague rage back in China. They knew that, once one case was found, it took off like wildfire. It wasn’t a trickle, like the one case here and other cases a week later they’d seen in San Francisco. Because cases in Chinatown were so few and far between, Chinese residents were very skeptical that their residents were actually getting sick from plague. One of the rumors that was spreading was that the public health authorities were actually infecting Chinese residents with plague. That wasn’t true, but it helps us understand that the trust had completely broken down. Public health officials who already believed that the Chinese were a vector had forced to quarantine, and now we’re planning to ban them from travel unless they’ve complied with the mandatory inoculation order.

Speaker 13: How this plays out is super interesting in real time. Like the quarantine measures, there’s massive Chinese resistance to the inoculation. So, the six Chinese companies and council general, Ho Yao, sent a telegram in 1900, for example, which noted that and he’s talking about the inoculation, the attempts at forced inoculation, all Chinese object would rather go back to China than subject. If they inoculate by force, there might be trouble in bloodshed and may lead to serious complications.

Padmini Raghunath: When the doctors and health officials came into the quarter to try and inoculate, almost all the businesses are shuttered. The Chinese workers and small shopkeepers are registering their refusal with a mass boycott. Many Chinese residents also tried to flee. Rumors were flying that the white health authorities are trying to inject Chinese people with poison. And people within the quarter were turning on those who they thought were conspiring with the white health officials.

Speaker 13: So, by June, Kinyoun and other public health officials in San Francisco tried another tactic. And this was one that, I think, they took directly out of the playbook of Haffkine in India. They tried for a kind of public health promotion campaign.

Padmini Raghunath: By this point, the Chinese laborers and small shopkeepers were angry that their leaders had seemingly sided with the elites of the city, because many of them were imploring people to get vaccinated. There was a kernel of truth in that rumor. Leaders of the Chinese quarter were desperate for this plague episode to be put to bed to avoid the financial consequences of the situation.

Speaker 13: They convinced a Chinese merchant, Kuan Chung, to publicly get vaccinated right in Chinatown. And he received the vaccine. He didn’t notice any side effects. But a group of angry Chinese residents were so embroiled about the attempts by white public health officials to forcibly inoculate them, that they turned against this Chinese merchant. They supposedly, he reported in the newspapers, chased him with bricks. He fled, but the mob attacked his grocery store and burned it to the ground.

Padmini Raghunath: During this time, the Chinese leaders had filed a court case to invalidate the travel restrictions on unvaccinated Chinese and Japanese. They won their case in the early summer. Judge Moro said that the measures were “boldly directed against the Asiatic or Mongolian race.” But when the travel restrictions were lifted, other states started considering imposing blanket quarantines on all freight coming from San Francisco. So, of course, the public health office hastily re-imposed a second quarantine on Chinatown in late May of 1900.

Padmini Raghunath: There is some evidence from private letters to suggest that, Kinyoun thought the quarantine, at least, was overstepping and could be thrown out as unconstitutional. Incredibly, through all of these actions against Chinatown, city and state politicians still denied that plague was spreading in San Francisco. The governor of California, Henry Gage, went so far as to accuse Kinyoun of importing the plague bacillus and planting it on dead bodies.

Speaker 13: Kinyoun is in the middle, is in the absolute middle of this controversy in San Francisco, and in some ways somewhat unfairly. His name gets dragged at the center for all of the ire, and he ends up leaving San Francisco and retreating to Detroit, Michigan.

Padmini Raghunath: After this, the inoculation push gets sidelined forever. The city and federal public health departments continue to keep Chinatown under surveillance, even when people outside the quarter become infected. The epidemic is declared over in 1904, after a new governor, George Pardee, finally acknowledges the plague and works with health officials to implement public health measures. This makes it hard to know what the actual figures are. The official death count is 113. Of those deaths, four identified as Japanese, two is white, and 107 is Chinese.

Lisa Berry Drago: Chapter Seven, Community Model Chinese Hospital.

Padmini Raghunath: Eventually, Lu Hang was driven out of business.

Bruce Quan: They finally took him down. I mean, they were finally able to use the government to basically drive him into bankruptcy to teach Chinese a lesson that they had to know their place back then.

Padmini Raghunath: But before he lost all his money, Lu Hang helped build institutions that the Chinese community could use and trust.

Bruce Quan: Emergency room.

Padmini Raghunath: So, this is it?

Bruce Quan: This is the hospital. This is, I think, the only ethnic-based hospital in America.

Padmini Raghunath: Bruce and mine’s last stop was to the San Francisco Chinese hospital.

Bruce Quan: These are all the people who had given money.

Padmini Raghunath: The front entrance of the building is on a street with a steep hill. On clear days, you have a view straight out over the Bay Bridge, which connects Oakland and San Francisco. And Bruce is right, it is the only ethnic hospital left in the country. Most others can’t compete financially with big hospitals.

Padmini Raghunath: And when was this built?

Bruce Quan: This has been renovated 120 years. This was built… 120, this has to be…

Padmini Raghunath: 1902.

Bruce Quan: This has to be the success of the Tung Wah Dispensary.

Padmini Raghunath: It is.

Padmini Raghunath: The Tung Wah Dispensary was organized by the Chinese in response to the plague. And in 1900, Lu Hang contributed funds for it to be built. It was the only proper facility that Chinese had to be treated for plague.

Jen Zheng: People just come in to ask questions. It’s not even healthcare-related. It’s just a system that they trust.

Padmini Raghunath: 2020 was the dawn of a new decade. But as the world rang in the new year, it was also starting to pay attention to a strange new virus that was ravaging a province in China.

Jen Zheng: I came from China. So, I finished the medical school training in China. And so, my colleagues there actually were deployed to help, help. And so, Wuhan’s situation, I was paying attention to that a lot.

Padmini Raghunath: They were seeing signs that this new Coronavirus could be really serious. January 25th of 2020 was Chinese New Year. The outbreak had just happened in December.

Jen Zheng: Our residents here we’re going back to China for vacation, too. And then, there’s the vet fly from here to Wuhan, 12 hours.

Padmini Raghunath: In San Francisco, Jen Zheng was watching the Coronavirus hit Wuhan, just like Chinatown residents had watched the plague strike Honolulu 120 years earlier. She was worried, so she started preparing. One concern was all of Chinatown’s single-room occupancy buildings, or SROs. These are single rooms for rent with shared kitchens, bathrooms, and living areas.

Jen Zheng: So, we did a walkthrough in Chinatown, like, to see where was the weakest spots. What can we do in this case? How can we isolate people or quarantine them in a doable way? Because there’s no way you can quarantine people in the SRO, because they share all those common areas.

Padmini Raghunath: They gathered PPE for their staff, and they started educating the community on safe practices, hand-washing, mask-wearing. They encouraged people to get tested. And the Chinese language media helped communicate the message.

Jen Zheng: I think the community was well-informed and they know what to do, and they will not panic.

Padmini Raghunath: On March 9th, a cruise ship called the Grand Princess docked in Oakland. It was carrying passengers sick with the novel Coronavirus. And a week later on March 16th, San Francisco issued its Shelter in Place order. Everyone was expecting an early outbreak in Chinatown. But with the early information and preparation, the Chinese hospital came up with a protocol. Because the hospital was so well-connected in the community, they would know very quickly if there was a case. They partnered with the city to set up quarantines and hotel rooms for SRO residents. And they set up a hotline for people to call if they had symptoms. They’d arrange for those people to be tested right away.

Padmini Raghunath: The Chinese hospital is an institution that people trust. And there are many reasons for that. Everyone knows each other. Everyone has family who’s gone there been, born there, been treated there. For people who are non-English speakers, hospitals can be a terrifying experience.

Jen Zheng: This one employee’s mom was hospitalized in another hospital, where she could not speak the language. She didn’t speak English. So, she was quarantined because she got COVID, right? And so, the families were not allow to see her because of the quarantine. And then the Shelter in Place Order, orders. Well, at that time, they couldn’t allow interpreter to go in either because of lack of PPE. So, a lot of reason costs her isolation. She became so depressed. Even when she passed away, the family was not there. They couldn’t say goodbye to their mom. They couldn’t be there to take care of her. And then, they always wonder how scared she must have been because that she couldn’t communicate to anyone.

Padmini Raghunath: Because the hospital had taken early precautions, they admitted fewer patients than they had planned for and they had enough PPE for their staff. And they were able to open up one of their floors for patients from other hospitals in San Francisco.

Jen Zheng: Now, this patient is, uh, mostly not Chinese. And so, they… when they came here, now again, now your Chinese food is not their preferred food anymore, right? We did the assessment. Quickly, our kitchen adjust to that. We provided Western food for those patients.

Padmini Raghunath: And when the vaccines became available, the Chinese hospital went to the community again. They managed to get a staggering 83% of eligible people vaccinated. Case rates in San Francisco Chinatown remained significantly lower than the San Francisco average, 28 cases per 10,000, as opposed to several hundred per 10,000. And it’s still, despite the low case rates, despite the fact that Chinese and Asian health providers risked and gave their lives to help people, the old narratives reared their ugly heads again.

Jen Zheng: Our HR manager was yelled at. And in public transportation, she got hit, too, and then got yelled at, saying, “Get out of here. Get back to China.” When our president called the virus Chinese virus, it definitely doesn’t help, right? The public now start blaming Chinese, kind of like history repeats itself, right? When bubonic plague hit United States, Asian was, more so Chinese, was blamed for bringing in the one the bubonic plague. When TB hits, smallpox hits, they always blame us for bringing the virus or the bacteria.

Padmini Raghunath: In other words, certain groups are still treated as vectors. But isn’t everybody flesh and blood? When we get sick, aren’t we all victims, in a sense?

Jen Zheng: Virus or bacteria, they don’t know colors. They don’t know, you know, you’re white, you are black, you are yellow, or you’re black. They will hit whoever. So, what we should do is that we should work together fight against the virus, not to blame. We suffer from it, too, right?

Bruce Kuan: When I was growing up, I grew up in a segregated society. And Chinatown is really a ghetto. And it really was not self-imposed. It was imposed by the larger society.

Jen Zheng: And this separation that was imposed by society, it meant that the Chinese had no way to get treated as patients. They couldn’t go to the hospitals. They couldn’t live or work in less crowded conditions. But in the midst of all this, the Chinese were able to make an institution for themselves that would be enduring. And that would help so many Chinatown residents through a pandemic more than a century later.

Lisa Berry Drago: This episode was recorded and produced by Padmini Raghunath, with additional reporting by Rigoberto Hernandez and additional production by Mariel Carr. And it was edited by Mariel Carr and mixed by Jonathan Pfeffer, who also composed our Innate theme music.

Lisa Berry Drago: Distillations is more than a podcast. It’s also a multimedia magazine. You can find our videos, stories, and podcasts at distillations.org. You can follow the Science History Institute on Facebook, Twitter, and Instagram for news about our podcasts and everything else going on in our museum, library, and research center. The Science History Institute remains committed to revealing the role of science in our world. Please support our efforts at sciencehistory.org/givenow. For Distillations, I’m Lisa Berry Drago.

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