Plague at the Golden Gate

♪ ♪ (distant rumbling) ♪ ♪ NARRATOR: January 20, 1900.

The skies above Oahu were black with smoke.

(fire crackling) Bubonic plague had been discovered in Honolulu's Chinatown and panicked health officials were doing everything they could to try to stop the spread.

DAVID MORENS: In those days, they didn't really understand how plague was transmitted, so the public health approach was isolate people.

They would wall off a whole area with police and checkpoints and wouldn't let anybody in or out.

But if they couldn't stop the problem, they would often do targeted burnings of buildings.

(hose spraying, people shouting in background) Their point of view is, you know, "We don't care what you do.

"If you have to burn the place down, just make sure that you contain this epidemic."

♪ ♪ NARRATOR: Desperate residents fled their burning homes as the fire spiraled out of control.

(people shouting) And mobs of white residents stood by with clubs and revolvers-- threatening to kill any Asian who tried to skirt the exit lane out of the quarantine zone.

♪ ♪ (fire crackling, water spraying) NAYAN SHAH: This is the Black Plague of the Middle Ages that wiped out one-third of the population in Europe.

♪ ♪ So, we have this sense if it wasn't stopped, the consequences would be unbearable.

NARRATOR: The fires burned for 17 days and left nearly all of Chinatown in ashes.

4,500 of its residents were homeless.

The most feared disease in history, bubonic plague, was an unsolved mystery.

It had decimated the populations of Europe and North Africa in two separate pandemics over hundreds of years, and the third was now raging across Asia.

♪ ♪ This was the start of the steamship era.

So now disease and people and goods can travel around the world incredibly quickly.

And the bubonic plague spreads along Hong Kong, spreads to Japan, it spreads to India, and millions of people start dying.

♪ ♪ At that time, there was still a medieval sense of what this disease was and how it was spread.

Many people thought it was "miasma"-- bad air-- or it was simply a disease of filth.

♪ ♪ Other people thought that this is only a disease of rice eaters.

♪ ♪ NARRATOR: Racism and ignorance were already in the air as the bubonic plague made its silent way across the Pacific.

♪ ♪ It would arrive in North America for the first time in history where it would spark nationwide terror, denial, and blame.

♪ ♪ Two men would try to stop it, struggling with not only the scientific unknowns, but unanticipated forces of politics, commerce, and race.

(seagulls squawking, waves lapping) ♪ ♪ (seagull squawking) ♪ ♪ NARRATOR: June 28, 1899: in the cold morning fog, a lone Italian crab fisherman made an unsettling discovery.

Two bodies were floating face down in San Francisco Bay.

♪ ♪ The previous morning, the Japanese steamship, the Nippon Maru, had arrived in San Francisco from Hong Kong, stopping at Shanghai, Yokohama, and then Honolulu.

Ominously, she flew a yellow flag: the international signal indicating disease.

♪ ♪ MARILYN CHASE: When the Nippon Maru entered San Francisco Bay, two stowaways, who evidently were ill, jumped overboard into the bay waters.

And when their bodies were recovered, the local doctors found them to be suspicious.

NARRATOR: Unnerved by both their autopsy findings and recent reports of plague in Asia, the city doctors immediately sent their results to Joseph Kinyoun, the nation's foremost plague authority, and the newly appointed head of the Marine Hospital Service on nearby Angel Island.

CHASE: Angel Island in San Francisco Bay had a quarantine station where cargoes and passengers were checked for all kinds of disease by the doctors of the Marine Hospital Service.

♪ ♪ NARRATOR: The Marine Hospital Service had been established 30 years earlier to treat sick seamen.

(indistinct chatter in background) But the idea of "public health" had since evolved into a matter of national concern.

The MHS was now charged with fighting the spread of epidemics using federal powers of quarantine and surveillance.

♪ ♪ RANDALL: Their main responsibility was protecting the people of the United States from the spread of disease around the world.

So, there were Marine Hospital Service officers stationed in Rome, in London, in Asia.

♪ ♪ NARRATOR: Just weeks into his posting, Kinyoun knew better than anyone that hospitals around the world were reporting 90% death rates from the plague.

And that millions had already perished from a pandemic that had been raging since the 1850s.

Although no one knew why, rats and filth had long been associated with plague.

Kinyoun ordered the "Nippon Maru" to be disinfected and checked for vermin before having all 55 passengers quarantined on Angel Island.

♪ ♪ Then he faced the most critical step of all: determining how the men had died.

JOSEPH HOUTS JR.: Kinyoun suspected plague.

And there was a little rattle in the papers.

♪ ♪ Well, Kinyoun thought the bodies were too far gone.

There wasn't definitive proof.

So the press kind of backed away, Kinyoun backed away, and everybody backed away.

♪ ♪ NARRATOR: A positive diagnosis would be calamitous.

But the condition of the tissue samples and decomposed bodies made forensic confirmation impossible.

Without scientific proof, Kinyoun could not assert that plague had arrived.

Yet his years of rigorous training had taught him to remain alert.

♪ ♪ CHASE: Joseph Kinyoun was a star.

He was beautifully educated.

He had studied with the best scientists in the world to learn the state-of-the-art methods of diagnosing infectious diseases.

Then, at the age of 27, while he was at the Hygienic Laboratory in New York, he diagnosed the first case of cholera with the new bacteriologic tests in the Western Hemisphere.

He was truly the elite of American scientists.

NARRATOR: But Kinyoun's meteoric rise was interrupted by personal tragedy.

♪ ♪ TRISH REEVES: Joe and Elizabeth Kinyoun's daughter died of diphtheria at the age of three.

It's a terrible disease to die from, and it must be devastating for a parent.

♪ ♪ RANDALL: Diphtheria at the time was one of the most devastating childhood diseases.

So, Kinyoun goes to Germany to work with Robert Koch, who had discovered these cures for diphtheria.

And he can't believe his own eyes, seeing these kids recover as if by magic.

And he can't help but believe that he's seeing his own daughter's face on all of these children.

And that really gives him this idea that medicine can conquer anything.

♪ ♪ NARRATOR: Kinyoun was fueled by not just a new sense of purpose but of possibility.

♪ ♪ DAVID MORENS: Joseph James Kinyoun, he was a very unique guy from the day he set foot in the Marine Hospital Service.

He was fascinated by technology.

He taught himself photography and radiology, which was a new technique around the turn of the century.

He was an inventor.

And he invented an enormous number of machines and devices to steam sterilize, for example, or chemically sterilize.

Any new technique, he was just in love with and he wanted to master it.

He was an early adopter of ideas.

♪ ♪ NARRATOR: The 39-year old scientist had already proven himself a leader in the fledgling fields of microbiology and infectious diseases.

Once in D.C., Kinyoun developed the Hygienic Laboratory into a national state-of-the-art research center, which supported the MHS by identifying diseases and controlling epidemic outbreaks.

CHASE: Dr. Joseph Kinyoun loved the National Hygienic Lab.

He and his young family loved the finer East Coast living and the cream of scientific society in Washington D.C.

However, Walter Wyman, the surgeon general of the Marine Hospital Service, his eye was on the West Coast, where he feared plague would be entering and he transferred the young Joseph Kinyoun to San Francisco to run the Angel Island quarantine station.

(wind whipping) And, of course, Kinyoun was not pleased about being dispatched to what he thought was this frontier outpost.

NARRATOR: The MHS quarantine station on Angel Island in the middle of San Francisco Bay was a jumble of filthy and neglected buildings.

(birds chirping) Kinyoun now had to contend with a workplace that was completely unsuitable to the urgent task at hand-- protecting the nation from a deadly epidemic.

MORENS: The Marine Hospital Service was a uniform branch of the United States government.

And Kinyoun himself, he's a very military guy.

He always followed orders, and he did what he was told, and didn't complain about it.

He was clearly the best man for the job.

He probably knew that.

So, as everything else, he threw himself into it 100%.

♪ ♪ (birds squawking) NARRATOR: From the moment Kinyoun assumed his post in California, he had been on high alert for plague.

San Francisco was not only the busiest port on the West Coast, but connected by rail to the rest of the country.

It was terrifyingly well-placed to spread disease far and wide.

♪ ♪ To miss even a single diagnosis could be cataclysmic.

♪ ♪ SHAH: Joseph Kinyoun is really intent on checking every ship from Asia.

Because after bubonic plague emerges in Honolulu, and is discovered in the Chinese quarter, it becomes kind of a confirmation bias.

It was only going to affect Chinese people.

That one could contain it in some way.

And that set up a terrible dynamic.

It only percolated more fear, more confusion, more misunderstanding.

And all eyes were targeted on a Chinese source.

(traditional Chinese music playing) (firecrackers popping) (music continues) ♪ ♪ NARRATOR: As the 20th century dawned, everyone celebrated.

♪ ♪ And no place had more optimistic swagger than San Francisco.

It was home to one out of every four people who lived west of the Rockies.

♪ ♪ A third of the nation's money west of the Mississippi flowed through her banks.

The city was a trading hub, the portal to the east, and the diamond in the crown of a state already rich with natural resources.

It truly was the city of the future.

CHASE: As a Gold Rush boom town, San Francisco had new money.

It had three opera houses, railroad and mining tycoons living in palaces on Nob Hill, and a new cable car system.

(cable car bells clanging) San Francisco in 1900 aspired to be the Paris of the Pacific coast.

(people chattering) NARRATOR: Nearly six percent of the city's population lived in a 12-block district.

HARRY CHUCK: Chinatown is home and it always will be.

My mother was born in the year 1900 in San Francisco's Chinatown.

And she lived in Chinatown throughout her entire life.

Because they didn't have any choices.

They were not permitted to move outside of the neighborhood.

Things were red lined, there was discrimination, and people were very stereotyped.

MAE NGAI: Chinatowns primarily exist because Chinese weren't allowed to live in white neighborhoods or any other neighborhood.

♪ ♪ They are what sociologists call ethnic enclaves, where people like to live with people who speak their language, or eat similar foods, or practice the same religion.

But they're also confining.

So, Chinatowns are a combination of ethnic solidarity and discrimination and exclusion.

♪ ♪ NARRATOR: As the Year of the Rat dawned on January 31, 1900, shop owners in Chinatown began noticing a disturbing sight: rat carcasses littered the district's alleys and courtyards.

And for 41-year-old Wong Chut King, something was definitely wrong.

A worker in a nearby lumber yard, Wong lived in the Globe Hotel on DuPont Avenue, the main artery of Chinatown.

♪ ♪ RANDALL: He shared one bed with two other men.

They'd take turns sleeping.

It was really a meager existence of survival.

He, like many people who came from China, expected their time in San Francisco to be short-lived.

They come, they make a lot of money, then they go back home a wealthy man.

That didn't play out for almost all of them.

♪ ♪ NARRATOR: For several weeks, Wong Chut King struggled with mounting fever, exhaustion, and painfully swollen lymph nodes, or "buboes."

Because city hospitals were closed to the Chinese, he sought traditional Chinese remedies, but nothing seemed to help.

Eventually, he was too sick to move.

RANDALL: His roommates, they see that he's dying.

They take him to a local, you know, what was called a Hall of Tranquility.

♪ ♪ GUENTER RISSE: The Chinese have a holistic view.

They believe that when they die, their spirit needs to be tended to.

And the remains had to be brought back because of their view that the ancestors played a great role in the afterlife.

NGAI: One of the sources of mistrust between the community and Western doctors was a very different view of life and death.

The body should not be cut, autopsies were anathema, one's soul had to return to one's home village.

So the Chinese were very careful.

CHASE: So, it was a quiet affair.

And Wong Chut King died alone, on March 6, 1900.

♪ ♪ (bell rings, horse hooves clomping) NARRATOR: State law required a physician to issue a death certificate so a health inspector was summoned to examine the body.

(horse whinnying) He notices a bubo in, in Wong Chut King's groin and he jumps back because he does know what this is.

He knows it's a sign of bubonic plague.

So, he figures that, "I'm going to take a sample of this tissue "from Wong Chut King's body.

"I'm going to run it over to Kinyoun at Angel Island.

"And I'm going to let him make the decision of whether this is plague or not."

♪ ♪ NARRATOR: Kinyoun knew all about buboes, where the word "bubonic" comes from.

The swollen lymph nodes were an infamous sign of the plague.

Yet he also knew that they weren't enough for a diagnosis and he had to be 100% certain.

♪ ♪ MORENS: To prove a plague death scientifically, you couldn't just do it by examining the live patient or the cadaver.

You had to isolate the organism from tissue.

♪ ♪ NARRATOR: In 1900, microbiology was still a fledgling field.

And the idea that germs could cause disease was not fully accepted, even by many doctors.

Kinyoun's superior, Surgeon General Walter Wyman, had himself published a paper on the plague that was full of speculations and misinformation: that the disease was spread by dust, tainted food, and contaminated objects.

Wyman also endorsed racial theories of the time that the disease targeted Asians while sparing whites.

RANDALL: Surgeon General Wyman, himself, said it was only a disease of rice eaters.

If you ate a "muscular diet of meat," you were somehow immune to it.

NARRATOR: Such ignorance was widespread due in part to the fact that scientific confirmation could take years.

Nevertheless, European scientists had recently identified the bubonic plague bacteria using a test called Gram's stain.

MAY CHU: Bubonic plague is transmitted by a bacteria called Yersinia pestis.

And Gram stains are used under the microscope to enhance the difference in colors.

So, you can see the bacteria in what we call a smear on a slide.

♪ ♪ And Yersinia pestis stains pink.

♪ ♪ NARRATOR: As the first American to have studied the bacilli, Kinyoun was unquestionably the most qualified scientist in the country to test for plague.

Hours after Wong's death, he undertook the exacting forensic work, using the sample taken from the body.

(glass clinking) CHASE: Isolate the germ in biopsy, test it with the Gram stain.

Put it under a microscope... ♪ ♪ And look for the distinctive pink rod-shaped bacilli with rounded tips.

And that was the classic signature of plague.

♪ ♪ NARRATOR: Yet the presence of the telltale marker alone wasn't enough to confirm a diagnosis.

Kinyoun would have to grow the culture in his lab, which would take time, and there was none to spare.

For he couldn't help but wonder: how many others might be infected?

♪ ♪ Across San Francisco Bay, the city board of health was too spooked to wait.

To them, it was clearly a "Chinese problem," confined to Chinatown.

So they decided to control matters by quarantining the entire district.

One day after Wong Chut King's death, the Chinese community awoke to find ropes cordoning off their 12-block district.

Overnight, 20,000 people-- nearly all of the city's Asians-- found themselves virtual prisoners.

McCLAIN: What was unusual was that it didn't apply to this one particular house where the man was found, but applied to the whole Chinese quarter, sealing off a whole area of a city.

SHAH: There was this kind of idea that the Chinese carry a particular virulent form of some kind of disease, whether it was smallpox, or syphilis, or bubonic plague.

And that the disease is endemic to their bodies, that it would be possible to infect innocent middle-class white people.

McCLAIN: There was definitely this view that Asians were more susceptible to the disease as opposed to whites.

And this was a widely shared view at the time.

♪ ♪ RANDALL: The residents of Chinatown were really stuck.

They weren't allowed to be citizens.

They weren't allowed to own property.

They weren't allowed many fundamental rights.

NARRATOR: In 1900, anti-Chinese sentiment wasn't isolated-- it was codified by federal law.

The Chinese Exclusion Act of 1882 prohibited all Chinese from citizenship, essentially relegating them to the margins of society.

♪ ♪ POWELL: The Chinese were already not seen as human before the Chinese Exclusion Act, which is why the act passed.

♪ ♪ The only time in our history that we specifically named an ethnicity to say they can't come to the United States; they don't belong, they're too different than us.

♪ ♪ CHASE: The building of the transcontinental railroad required tons of hard labor, which Chinese workers had taken on.

Once that final golden spike was driven, the welcome mat was withdrawn.

And the once-essential Chinese workers were regarded as a surplus that would cut into demand for white labor.

So, the white labor movement was very hostile.

(crowd shouting) NGAI: Almost 20 years have gone by since the Exclusion Act.

And this has been a very tumultuous number of decades where the government tries to take this right away, impose that discriminatory law, to try to drive people away.

NARRATOR: The Chinese community saw the cordon for what it was: the latest unjust action taken against them based on flimsy evidence and a convenient excuse.

CHASE: The populace was violently opposed to being sealed inside Chinatown.

Many people worked outside the district.

They had jobs to get to.

And interestingly, the white community, while not so sympathetic to the viewpoint of the people in Chinatown, wanted their cooks and gardeners and domestic back on the job.

And so all sides were at war.

And by March 10, the ropes came down.

McCLAIN: So, the first quarantine of Chinatown, it didn't last very long-- only three days.

RANDALL: Because the quarantine came down so quickly, many people in San Francisco thought it was just all a sham.

It almost eroded public trust immediately.

NARRATOR: In the face of such apparent incompetence, the city's response was one of relief-- and amused contempt.

CHASE: One of the papers celebrated the end of the first quarantine by writing a silly poem, ""Sweet Fong is at his post once more And cooking reigns supreme."

Because the people had gotten their domestic servants back.

It was that kind of racial supremacy emanating from every corner of the city.

♪ ♪ (birds chirping) NARRATOR: Alone in his lab on Angel Island, Kinyoun had managed to successfully grow the microorganism within 48 hours.

But the next step-- injecting it into a healthy animal to see what would happen-- would take days.

Once again, Kinyoun took extra precautions, choosing to inoculate not one but four lab animals: two guinea pigs, a rat, and a monkey.

(animals chittering, glass clinking) HOUTS JR.: Three of the animals died pretty quickly.

The last one, the monkey, was the one he was hoping on.

If it didn't die, then maybe it's not the plague.

Well, it died.

♪ ♪ NARRATOR: On March 13, seven days after Wong Chut King passed away, Kinyoun was finally able to confirm the cause of death.

♪ ♪ Wong became the first diagnosed case of bubonic plague in the United States.

But Kinyoun feared he would not be the last.

♪ ♪ (machine clicking) RANDALL: Kinyoun immediately sends a coded telegram to D.C. "Bumpkin confirmed."

And that was the code word that plague is here.

MORENS: Kinyoun's boss Walter Wyman had every reason to believe that if it got out of San Francisco, it would go over the whole country and countless deaths would occur.

♪ ♪ So, the people in Washington were just alarmed, and their point of view is, "We don't care what you do.

"If you have to burn the place down, "just make sure that you contain this epidemic.

It's a national emergency."

♪ ♪ NARRATOR: As federal officials frantically tried to coordinate a response, word of Kinyoun's diagnosis spread quickly among San Francisco's leaders.

Yet powerful merchants and politicians like Mayor James Phelan refused to accept his findings.

(seagulls squawking) RISSE: Shipping exchanges around the world was very, very important source of income.

So, if there was plague in San Francisco, it would be blocked, it would no longer be open.

So industries were at stake.

McCLAIN: Mayor Phelan was very concerned that if word got around that San Francisco had cases of plague that the city's commerce would be dealt a really serious blow.

NARRATOR: City leaders were used to autonomy, and didn't like being told what to do, especially by authorities at the federal level.

♪ ♪ (birds chirping) SHAH: With the Marine Hospital Service, the federal government, they were now centrally becoming involved in public health across the United States.

And they felt they had supreme authority.

But the city government, the merchant elite was saying to them, "We have jurisdiction in San Francisco."

And then there were state officials and the governor who thought, "Well, we have authority over all of California."

And it becomes a question immediately of who has authority.

If there is an outbreak, is this a federal responsibility?

Or is this the city, or is it the state?

NARRATOR: Most San Franciscans didn't care.

They couldn't be bothered with the death of a faceless stranger in Chinatown, especially given widespread beliefs that whites were immune.

As for city leaders, while they refused to accept Kinyoun's diagnosis, they did agree that what they called the "Chinese problem" needed to be contained.

MORENS: They didn't really understand how the bubonic plague was transmitted to people.

But they knew if it occurred in a city it would be in one area.

And so, the public health approach was to find the focus and go in there and do whatever you could to get rid of the disease.

NARRATOR: The moment Mayor Phelan declared "Asiatic infections are a constant menace to San Francisco's public health," 75 health inspectors and dozens of policemen, armed with sledgehammers and axes, descended on an unsuspecting Chinatown.

They smashed down doors, ransacked homes, stole brazenly, and beat anyone who stood up to them.

CHASE: They were subjected to plague measures, which included torching of belongings, they would bring in smudge pots of sulfur, and fumigate a building.

If you were a merchant selling fine silks or ceramics, it would spoil your goods.

So, these measures, which were crude and discriminatory and not very effective, frightened the populace.

People were not eager to report a case of sickness in their home.

♪ ♪ BRUCE QUAN JR.: In 1900, at the time of the bubonic plague, my great-grandfather had a business called the Pacific Fruit Packing Company.

And my family lived above the cannery on Stockton Street in Chinatown.

They went to church where Ng Poon Chew was the assistant pastor.

And that's how when he started a newspaper, my great-grandfather helped him fund the "Chung Sai Yat Po."

And in Chinatown, they would post some of the newspapers on the walls.

So the Chinese knew exactly what was going on.

♪ ♪ SHAH: Ng Poon Chew and his newspaper documented what the deeply felt fears and concerns were of Chinese laborers, how they distrusted Western medical authority, how they feared what was going to happen to them from a Chinese perspective.

MAN (reading): "Alas, why should Chinatown's good name depend on "the life and death of a monkey?

"We don't know whether they are rooting for Chinatown or the monkey."

"Chung Sai Yat Po Daily."

♪ ♪ NARRATOR: Nine days after Wong Chut King's death, Kinyoun confirmed three more cases-- all within Chinatown.

♪ ♪ Kinyoun had feared such an outbreak all along, knowing that even a handful of cases could explode exponentially into a national epidemic within weeks.

The urgency of the situation caught the eye of newspaper magnate William Randolph Hearst.

On March 18, his paper, "The New York Journal," published a special national edition trumpeting the sensational story from California.

Pressured by commercial stakeholders, San Francisco's leaders quickly responded, enlisting the editors of leading newspapers to dismiss what they now called "rumors."

RANDALL: City Hall and all of San Francisco's elite, they had the same idea in mind, "We're not going to report any news of the plague."

You have the "Chronicle" saying, "We're gonna write an editorial "saying that Kinyoun or anybody else from "Marine Hospital Service is just trying to pick San Francisco's pocket."

CHASE: Dr. Joseph Kinyoun was a proud man.

He regarded the tools of science, the enlightenment of his technology, as a gift.

And he expected, quite rightly, some deference and respect for what he brought to the city.

And he got none of it.

Because from the moment that Joseph Kinyoun diagnosed plague in the glands of Wong Chut King, science was on trial.

♪ ♪ And Bubonic plague was called "Kinyoun's fake."

♪ ♪ (bird squawking) NARRATOR: As the media storm swirled around him, a frantic Kinyoun tried to retrace the last days of each victim's life in a desperate attempt to determine who or where the next might be.

RANDALL: What made Kinyoun so terrified when he started identifying the disease, was he found one victim and he could not find any connections to the next victim.

♪ ♪ It's almost like you're looking at the ocean, and you can't see it, but you know something is down there.

And he had no idea what it was.

CHASE: It was a mystery.

There was a kind of creeping pace.

There would be a case or two, and then it would pause.

Kinyoun tried to puzzle it out.

MORENS: He was looking for other cases of plague.

He also knew that because of the way Chinatown was being treated by local officials, they might hide cases.

♪ ♪ MAN (reading): "Suspicions everywhere and every shadow becomes an enemy."

"Chung Sai Yat Po Daily."

CHASE: A plague death would require autopsy to confirm the case.

It was an offense in the culture.

So no one was eager to call in the scientists.

RANDALL: And it becomes a cat and mouse game.

And people keep on questioning him.

If the plague is as scary as you're saying it is, there should be bodies everywhere.

We should also see living victims who are struggling with this.

♪ ♪ McCLAIN: People thought, "Well, if the plague existed, "it should be spreading like wildfire.

Why aren't hundreds of people infected with it?"

And it obviously made things difficult for Kinyoun, because in the face of pretty clear evidence, people denied that the plague existed at all.

♪ ♪ NARRATOR: When three more people died in mid-May, Kinyoun telegrammed Wyman urging a bold and unprecedented plan.

He proposed vaccinating every Chinatown resident with the recently developed Haffkine vaccine.

In 1900, vaccination was still a frightening concept to most.

But in Chinatown, the proposal was further complicated by the dark racial dynamics of the time.

♪ ♪ MORENS: There'd been a long history of white people, European-descended people, treating the Chinese in San Francisco badly.

So, the rational expectation was, you know, if the white power structure wants this done, there's gotta be something wrong with it.

NGAI: The Chinese relationship with city health authorities, there was nothing positive about it.

There was a history of malignant neglect.

Chinese were routinely refused treatment at city hospitals.

It was only that year that a Chinese clinic was allowed to open in Chinatown called the Tung Wah Dispensary.

So Chinese had absolutely no trust in city health authorities.

Also, they weren't vaccinating white people.

So it seemed to be targeted at them.

NARRATOR: The Haffkine was largely untested.

Existing data showed only a 50% protection rate.

Furthermore, the drug's purported side effects were so notorious that a headline-hungry reporter from a Hearst newspaper volunteered to be injected himself.

♪ ♪ MAN (reading): "Within two hours, the serum had spread "through my system and its effects began to be felt.

"Shooting pains extended through the chest, down the arm, "and even into my neck and head.

"My left arm felt numb.

The pain in my shoulder, chest, neck, and arm was quite severe."

♪ ♪ NARRATOR: Out of thousands of Chinese living in San Francisco, only 53 were willing to be vaccinated.

Growing desperate, Kinyoun telegrammed Wyman.

JOSEPH KINYOUN (dramatized): Regard situation very serious.

Will require almost superhuman efforts to control now.

So much time has been lost.

MORENS: And that's when Marine Hospital Service had to make its first authoritative stand against plague.

(machine clicking) RANDALL: Surgeon General Wyman telegraphs Kinyoun immediately, saying, "You are our man in San Francisco.

"It all depends on you.

You know, you have to protect us all."

NARRATOR: Now charged with overseeing the entire West Coast, Kinyoun quickly hired additional officers, whom he dispatched across California and Oregon to beef up inspection and patrols.

He also made vaccination mandatory, and took exclusive aim at not just the Chinese, but Japanese with an unheard-of travel ban.

McCLAIN: On May the 18th, the Board of Health of San Francisco passes a resolution to order the transport companies to refuse transportation to Chinese and Japanese without the certificate that said that the person had been inoculated with this Haffkine's vaccine.

And it's quite clear that they have endorsed the recommendations that have been passed onto them by Kinyoun.

So now the Chinese and Japanese are being told, "Do it, or you're confined to San Francisco.

You won't be able to leave."

It was being pushed on them coercively.

♪ ♪ MAN (reading): "The doctors are about to compel our Chinese people "to be inoculated.

"Tomorrow, all business houses large or small must be closed and wait until this unjust action is settled."

"Chung Sai Yat Po Daily."

NARRATOR: Its back to the wall, a defiant Chinatown turned to its own leaders: a consortium of district associations called the Chinese Six Companies.

NGAI: The leaders of the Six Companies were the biggest merchants in Chinatown, the most influential members of their associations.

Any dispute with the city government or the state government, Chinese would send their representatives to negotiate or to protest.

NARRATOR: The Chinese leaders met with Kinyoun at the consulate and implored him to call off his plans.

When he refused, the Chinese felt they had no option left but to take to the streets.

From the most powerful merchant to the lowliest worker, all of Chinatown took immediate action to protest Kinyoun's orders.

(crowd shouting) CHASE: There were riots.

A thousand Chinese protesters descended on Portsmouth Square in Chinatown where federal doctors had set up tents to vaccinate people.

(crowd shouting, whistle blaring) And they pulled cobblestones out of the streets and threw them in shop windows, pitching furniture into the street.

(shouting, whistles continue) They stood up to him, and they said, "We are not standing for these measures."

♪ ♪ MORENS: It was so terrible that a hundred police had to protect Kinyoun because the San Francisco mobs would have killed him.

♪ ♪ NGAI: The Chinese in San Francisco are beleaguered, but they also have fought every inch of the way with legal cases that are brought by the leadership of the community, the merchant leaders, sometimes together with the Chinese Consul.

(chuckling): They sued the government over everything.

♪ ♪ NARRATOR: Chinatown rose up as one to fight the travel ban.

Within days of the mandate, a class action suit was filed, naming Kinyoun and the San Francisco Board of Health.

CHASE: A businessman named Wong Wai sued, he went to court, and he charged that Dr. Kinyoun and everyone involved had violated the rights of the Chinese.

(gavel banging) McCLAIN: There was a petition for an injunction to stop the health authorities from preventing people from leaving the city.

It was racially discriminatory and that was forbidden by the 14th amendment, which says, "No state shall deprive any person of life, "liberty, or property without due process of law, "nor deny to any person within its jurisdiction the equal protection of the law."

The Chinese were not eligible to become citizens, but they had secured for themselves recognition as constitutional persons.

And as such, they came under the protection of the 14th amendment.

SHAH: What you end up having for the court case is a question.

Is this a kind of unfair use of the law that targets one group racially unfairly?

CHASE: The judge agreed with the Chinese.

And he said, "I see no proof that you've offered "that this is a disease more likely to be contracted by or transmitted by Chinese people."

He said, "This travel ban had been illegally applied "with an evil eye and an uneven hand, "focused on racial theories of disease transmission-- completely unscientific."

♪ ♪ NARRATOR: In addition, the judge issued a restraining order against Kinyoun and advised him and the MHS in no uncertain terms to back off.

Stung by the emphatic ruling, Kinyoun wired his fears to Wyman.

KINYOUN (dramatized): Believe situation to United States very grave.

The decision practically nullifies all acts of federal government.

Most serious blow Service has received.

♪ ♪ NARRATOR: Unwavering in his convictions, Kinyoun ignored the judge and continued to enforce the known scientific measures of isolation and sanitation.

He pushed for camps on Angel Island, as well as remote Mission Rock, to detain people even suspected of having the plague.

CHASE: There were now threats to remove people forcibly from Chinatown.

♪ ♪ And at the head of it all was Dr. Kinyoun, so he was called the Wolf Doctor.

♪ ♪ He acquired this nickname for what was perceived as this snappy and officious manner-- aggressive, an assault on people, kind of adding insult to injury.

♪ ♪ MAN (reading): "The wolf doctor is baring his claws and teeth.

"Enforced relocation to an icy remote island renders us without wings to fly."

"Chung Sai Yat Po Daily."

NGAI: The city and the health authorities were never really interested in ameliorating the conditions in Chinatown.

What they wanted to do was isolate the Chinese community, protect white people, and that was their goal.

So there's very little space to gain people's trust because the whole thing is rotten.

♪ ♪ NARRATOR: And now, other states were starting to put commercial pressure on California as well.

Everything erupted in an acrimonious three-day meeting-- with Kinyoun weighing in forcefully.

(people chattering in background) McCLAIN: The state of Texas was preventing people and products from San Francisco, from entering Texas.

So, the state board of health was putting tremendous pressure on the local board of health and says, "What you need to do is quarantine Chinatown."

♪ ♪ NARRATOR: On May 28, Kinyoun privately exulted when the state health board secured what he had long thought was the best option-- a full lockdown of all of Chinatown, indefinitely.

Within hours, 159 policemen descended on the district, working in three around-the-clock shifts.

(whistling, people shouting) McCLAIN: They start putting barbed wire around the quarter, they start putting a wall up around Chinatown.

It becomes very clear to the Chinese that this is not like the first quarantine.

♪ ♪ The Chinese were very, very upset immediately, as soon as the quarantine was declared.

NARRATOR: Once again, nearly 20,000 people were locked down.

They had no idea when they would be allowed out or whether the authorities might even attempt to burn down the district like Honolulu only months before.

♪ ♪ With no streetcar service, or incoming shipments of food and other vital supplies, panic quickly spread.

♪ ♪ POWELL: It was very draconian for the Chinese.

You had this complicated interaction between the city, state, and the federal government.

But there was almost a consensus that, among all of them, that somehow the heart of the problem were the Chinese.

And if we could just control the Chinese, we could control this plague.

♪ ♪ SHAH: People had that sense of doubt.

Is this the way in which the health officials who never cared about our wellbeing want to eradicate us?

♪ ♪ NARRATOR: Once more, the Chinese turned to the most powerful tool they had.

♪ ♪ McCLAIN: They file suit again.

And this leads to the second case, Jew Ho vs. Williamson.

And, again, Kinyoun was a named defendant.

CHASE: A grocer on Stockton Street, Jew Ho noticed that the quarantine lines were not drawn in a straight line around all businesses in the region, that they zigged and zagged to exclude white merchants.

And was specifically designed not to protect the health of an entire district, but to isolate the Chinese.

♪ ♪ BRUCE QUAN JR.: The quarantine line was along Stockton Street, so the cannery was in quarantine.

And the white workers, women and girls, employed by Lew Hing in the cannery, they were allowed to come and go, but not the Chinese.

McCLAIN: The judge says, it's very clear that the Caucasians on the perimeter are being treated differently.

And it has to do with whether this is a reasonable exercise of the police power.

And again, the court says no, it isn't because the Chinese are not being protected at all.

They're not being prevented from intermingling with each other; the individuals who had contact with these people who died of the plague have not been quarantined.

So, if the idea is to prevent the spread of a contagious disease, isn't this an unreasonable way to do it?

(gavel banging) ♪ ♪ NARRATOR: A day after the ruling, Kinyoun imposed a sweeping travel ban on all Californians, regardless of race.

This meant no one could leave the state without a health certificate from him.

And, of course, that made him a menace to the entire city and the whole state of California.

Dr. Kinyoun was a top-down officer.

He led by issuing sound scientific diagnoses.

That plays very well in the lab, and not so well on the street.

(trolley clattering) NARRATOR: Three days later, on June 19, 1900, Kinyoun was dealt a stunning rebuke.

President William McKinley was forced to apologize to enraged state legislators for the actions of his federal officer and swiftly revoked the travel ban.

Desperate to do the right thing, Kinyoun had played his biggest card and lost.

(bell ringing) But the situation only worsened.

Until now, there had been 13 confirmed plague deaths, all Chinese.

From the beginning, racial pseudoscience had lulled many into the complacency of ignorance.

What's more, the disease came and went in mysterious and inexplicable waves.

Kinyoun feared that the plague was spreading in darkness.

This was confirmed in mid-August when the first known white victim, William Murphy, fell ill and died.

A worker who routinely made deliveries to Chinatown, he was succeeded that fall by another non-Chinese victim, a nurse at the children's hospital, who had never been to the district.

♪ ♪ Panicked that the disease had begun to spread beyond Chinatown, Kinyoun put all his men on high alert.

(ship horn blares, birds squawk) Late that September, a steamship called the Coptic arrived from Hawaii and docked at Angel Island.

An overzealous health official ordered that all passengers, rich and poor, male and female alike, be strip-searched en masse and examined for buboes in the armpits and groin.

First-class passengers were outraged, and vowed to never again sail into San Francisco as long as Kinyoun was in charge.

CHASE: And now, everyone is out for blood.

♪ ♪ RANDALL: The state senate in California, say that Kinyoun should be hung for what he's doing.

CHASE: He had been decried by the politicians, by the press.

The legislators want him to leave, lobbying the federal government for his transfer out of the city.

By now, Dr. Kinyoun had been smacked down in the courts.

He was defending his hypothesis, his diagnosis, his standing in the Marine Hospital Service.

So he's literally a man under fire, besieged.

♪ ♪ KINYOUN (dramatized): It appears to me that commercial interests of San Francisco are more dear to the inhabitants than the preservation of human life.

I am at war with everybody out here.

Joseph Kinyoun.

California's Governor Gage spun a fantastic conspiracy theory.

He said that Dr. Kinyoun and the federal doctors had actually created a fake plague by injecting corpses with plague bacteria that they had secretly imported.

That it was all made up.

And he planted the seed of doubt in people's mind.

This was too much for Dr. Kinyoun.

And in despair and anger, he wired his boss, Surgeon General Walter Wyman, and said, "Please defend me from this slander against myself and the Marine Hospital Service."

NARRATOR: But Wyman chose to remain silent.

Kinyoun was left defenseless, and utterly alone.

In despair, he wrote to a colleague.

(typewriter keys clacking) KINYOUN (dramatized): My exoneration rests upon Dr. Wyman openly avowing his responsibility for my official actions.

This he should, if he possesses the courage of a man.

All these years I have stood loyally by his side... keeping his political head from rolling into the basket.

HOUTS JR.: It took a lot of stamina and guts to stay the course, that what he believed in.

'Cause he knew it, where everybody else doubted him.

♪ ♪ NARRATOR: Barely nine months since his first forensic diagnosis, Kinyoun confirmed the 22nd known plague casualty.

Seeking vindication, he now demanded a thorough, outside investigation into the truth of the matter.

Meanwhile, word of San Francisco's troubles continued to spread across the country.

MORENS: It became obvious to everybody in the country that San Francisco had an epidemic and they weren't admitting to it.

♪ ♪ The federal government and the state government of California were at a standoff.

So, a deal was cut that there would be a neutral federal commission.

Three of the most prominent bacteriologists in the United States would go west to investigate and find out whether there really was a plague epidemic, and whether Kinyoun was doing the right things or the wrong things.

(train horn blares, steam hisses) RANDALL: Kinyoun, was looking for that sense of validation.

He felt like he was 2,000 miles away from anybody he'd consider his peer who he trusted.

You know, "Finally, here are people who care about science, "who care about medicine.

"And now I'm going to be validated, "and we're going to save, you know, thousands, if not millions, of lives."

NARRATOR: When the three-man commission arrived in San Francisco in late January 1901, they felt the full urgency of their mission.

Sensing they had to penetrate Chinatown, they immediately hired a local translator and go-between, a former Six Companies secretary named Wong Chung.

RANDALL: He was the link between medical establishment, San Francisco establishment, the Chinese Six Companies, and Chinatown itself.

♪ ♪ NARRATOR: The move paid off.

With the help of Wong Chung, and with Kinyoun safely on Angel Island, the commission was quickly able to gain what had been missing for months: not just trust, but access.

♪ ♪ Within weeks, they confirmed six new cases.

When Governor Henry Gage learned of the commission's upcoming report, he panicked.

He hastily made a trip to Washington D.C., accompanied by a hand-picked army of the most powerful men in California: senators, newspaper editors, and business leaders.

♪ ♪ CHASE: When he arrived in Washington, he visited Surgeon General Walter Wyman, and he proposed a quid pro quo.

He said, "We will clean up the city of San Francisco "if you keep the existence of plague secret from the nation."

(engine puttering, trolley clanging) NARRATOR: Both sides had much to gain.

California needed the White House to put an end to the matter that was threatening to take down its economy and reputation.

And McKinley needed the vote-rich state to ensure his upcoming bid for re-election.

All of the men now agreed: one hand would wash the other.

(footsteps echoing) MORENS: And this unholy deal was undertaken in the office of the President of the United States-- President McKinley, in concert with senior Republican leaders, including those from California.

CHASE: And they struck a deal with the surgeon general to maintain what Dr. Walter Wyman, surgeon general, called a perfect seal of silence.

They would hush it up.

NARRATOR: On March 6, 1901, exactly one year since Wong Chut King's death, a local headline blared an unexpected and scandalous scoop.

CHASE: Reporters broke news of this infamous pact signed by the surgeon general and the governor of California.

♪ ♪ And word got out about this cover-up.

♪ ♪ NARRATOR: Wyman found himself in an uncomfortable position.

Yet he also knew that much of the vitriol aimed at the MHS had been greatly exacerbated by Kinyoun's actions.

His perceived lack of diplomacy was all anyone could talk about.

Kinyoun had to be thrown under the bus.

And so he was removed from his job without any real explanation for why.

NARRATOR: In May 1901, Kinyoun was ordered without thanks, fanfare, or even notice, to pack up his family and relocate to Detroit.

♪ ♪ He had spent two long years trying to protect the country, and seemingly all in vain.

REEVES: It was such a devastating blow because it basically ended his scientific career in many ways.

He did not get to go back to his beloved lab.

And I think that was devastating.

MORENS: And I think he believed he had spent his life doing really good things, and he was very proud of that.

And I think to be thrown under the bus was probably devastating to him.

Because it called into question the goodness of all those things he'd been doing for so long.

CHASE: Dr. Kinyoun did the hard work of nailing the scientific diagnosis.

He just couldn't make it stick in the minds of the populace.

And he was hurt, he was indignant.

And being somewhat hot-tempered, he didn't go quietly.

♪ ♪ He blasted the city, blasted Chinatown, blasted all the authorities.

NARRATOR: Kinyoun had come to San Francisco expecting to champion science and save the country.

Instead, he had been sent away in ignominy, while the danger still remained.

("Hail to the Chief" playing) NARRATOR: With Kinyoun gone, California turned to happier business.

As their part of the secret deal brokered months before, state politicians welcomed President McKinley to a lavish, all-expenses-paid junket.

(crowd cheering) Meanwhile, Wyman was on the hunt for a new quarantine officer.

But after Kinyoun's humiliating ouster, no one in the MHS community wanted what they saw as an impossible job.

("Hail to the Chief" ends) ♪ ♪ He finally settled on a candidate: Rupert Lee Blue, a 32-year old physician from the MHS.

Unlike Kinyoun, Blue wasn't a research scientist.

He lacked Kinyoun's medical pedigree and rigorous training.

In fact, he wasn't Wyman's first or even second choice.

CHASE: Rupert Lee Blue, or Pert as he was known by his nickname, was round-faced and shy.

He was diffident.

And he really loved boxing matches.

(crowd shouting) Not just as a spectator but also as an amateur participant.

♪ ♪ He was preceded by rumors that he was lazy, as one of his colleagues called him "inert."

"Inert Pert."

RANDALL: He was known as kind of affable guy, not necessarily the most accomplished.

Other people thought of him as, you know, somebody who is barely getting by, but it's hard to be that critical of somebody you like, you know, or somebody who's friendly.

(birds chirping) NARRATOR: The sixth of eight children, Blue was born three years after the end of the Civil War to a struggling but respected family in Marion, South Carolina.

(horse whinnying) RANDALL: Blue came from nothing, essentially, and grew up in the fields.

He'd walk with his siblings, bursting open watermelons with his fist and eating right there in the fields.

(child shouting in distance) He knew he was not the most favored son.

His older brother, Victor, was a war hero.

And the parents idolized Victor.

Rupert Blue kind of felt that "If Victor's purpose in life is to harm, perhaps my purpose in life is to heal."

So he went into medicine.

And went to one of the first public medical schools in the U.S. ♪ ♪ He wrote letters to his mom saying, "I don't think I can hack it.

I can barely survive."

And he barely graduated medical school.

♪ ♪ NARRATOR: Blue joined the Commissioned Corps of the Marine Hospital Service.

The MHS represented adventure with a purpose, the chance to see a world bigger than that of his small-town boyhood, and to confront diseases he had only read about in school.

As a quarantine officer, he tracked yellow fever in Galveston, monitored infectious diseases in Milwaukee, and investigated possible plague cases in Rome.

CHASE: He had to work hard.

Having lost his father to illness, he had to send money to his widowed mother and to his teenage sisters at home.

RANDALL: So he was working in the Marine Hospital Service, and also taking all these other side jobs as editor of a medical bulletin or a newsletter just to try to bring in more money.

(trolley clanging, people chattering) NARRATOR: The new posting in San Francisco, commercial hub for the nation and Asia, was a huge step up from monitoring shipping fleets on Lake Michigan.

It was a high-profile chance for Blue to prove himself, although it came with seemingly insurmountable obstacles.

Chinatown feared and distrusted the MHS and its agents.

City leaders were openly vying for their own interests.

State officials still refused to acknowledge that the disease even existed.

♪ ♪ By June 1901, there had been a total of 34 official plague deaths, so Blue knew he had no time to lose.

(child chattering) CHASE: The first thing he did, he moved into the city and he set up a lab right on Merchant Street, which is Chinatown, and he was comfortable there.

(horse hooves clomping) RANDALL: He would literally just walk into shops and start talking to people and trying to make those kinds of friendships and forge those social bonds.

And Kinyoun, when he went into Chinatown, he had to have a protection of armed officers.

Blue, he would walk down the streets by himself.

♪ ♪ NARRATOR: Blue also kept on Wong Chung, the interpreter who had assisted the federal commission.

And since he knew that Chinatown's dead seemed to mysteriously vanish, he talked Surgeon General Wyman into an unusual expense.

RANDALL: He arranged for a horse and buggy to have his own, essentially, morgue service, so he could find bodies and he could inspect them as quickly as he could.

Blue also paid the Chinese translators the same as he did as his white members of the staff, which was radical at the time.

He found himself relying more and more on his translator, Wong Chung.

Not just as a translator and interpreter, but also as a sort of cultural liaison.

So, Wong Chung helped Dr. Blue understand the community's resistance to Western medical interventions.

♪ ♪ (people chattering) NARRATOR: With Wong as his trusted go-between, Blue revised the harsh protocol of his predecessor.

He disinfected only targeted houses, not whole streets.

He quarantined immediate family alone, and limited lockdown to the shortest time possible.

RANDALL: He was somebody who was willing to listen, which was a real skill.

He knew he wasn't the smartest.

He knew he didn't necessarily have insights that other people did, but he was willing to, to try everything.

♪ ♪ NARRATOR: But what Blue discovered was unnerving.

In the month of July, three Japanese prostitutes working on the edge of Chinatown died.

Blue reeled at the thought that the women had had contact with literally dozens of nameless customers.

How many were there?

Where did they go?

Blue was terrified that the disease was poised to explode exponentially, as he admitted to Wyman.

RUPERT BLUE (dramatized): It would not be an easy matter to trace the source of this infection.

The Chinese seem to know a suspicious case and depart, like the fleas.

Rupert Blue.

RANDALL: On the big map right behind his desk, he starts putting red marks everywhere there's a known plague victim.

And that becomes this obsession to try to prevent more red marks from showing up on his map, but also to try to find some kind of connection between these victims.

♪ ♪ NARRATOR: For the rest of the summer, Blue patiently continued to explore Chinatown, always on the lookout for more cases.

♪ ♪ On September 11, 1901, following a tip from Wong Chung, Blue and his men had a rare opportunity.

In the basement of a grocery store, they found a 28-year-old man with signs of the plague, and took him to the Tung Wah Dispensary for observation.

CHASE: Well, friends of the patient were about to get him out of Chinatown to avoid the red tape, the inspections, the interventions.

But Wong Chung's tip enabled the federal doctors to prevent this evasion.

NARRATOR: It was the first time Blue had had the opportunity to examine a living patient.

Until now, the Chinese had never trusted the MHS enough to cooperate.

Blue was able to isolate the man and question him about his contacts to hopefully learn how the disease was being spread.

Thanks to Wong Chung's quiet diligence, Chinatown was starting to open up.

Cases that had formerly been hidden or misdiagnosed were coming to light, leading to a wave of ten more confirmed diagnoses.

BLUE (dramatized): I am working like a Trojan.

and I trust that my labors will be rewarded.

We are still working quietly, avoiding friction with the state or the Chinese.

Rupert Blue.

RANDALL: He soon finds more and more victims.

He sees living victims.

He sees more victims quickly before they can be hidden away.

So he starts realizing the scope of the problem.

CHASE: So, Wong Chung played a pivotal role, and for this he took many risks.

♪ ♪ The state doctors who denied the plague existence may have tipped Chinatown gangsters that Wong Chung was a collaborator, a traitor to his community.

Not that long after, someone tried to kill him.

♪ ♪ And he had to run for his life, essentially.

(loud clattering) CHASE: It took the intervention of Washington, and only then was Wong Chung secure to go about his medical rounds with the doctors.

(bell tolling) NARRATOR: For 18 months, Blue, like Kinyoun before him, had been confounded by the low number of fatalities, but neither man had had the full picture.

♪ ♪ Blue began to realize that white doctors throughout San Francisco, bowing to political pressure, were deliberately misdiagnosing cases in order to minimize actual numbers.

BLUE (dramatized): Scant courtesy, singular apathy, and, in the end, interference, have characterized the state health board at a time of grave public peril.

Eradication of the disease would be entirely out of the question, and the danger of an indefinite stay is enhanced.

Rupert Blue.

♪ ♪ NARRATOR: By the fall of 1902, the number of officially diagnosed cases had tripled.

♪ ♪ At the annual meeting of state and local health boards in New Haven, Connecticut, San Francisco was all everyone talked about.

California officials continued to deny that the plague existed, in direct contradiction to the MHS and national papers.

CHASE: Other state boards of health started issuing censure votes and statements of condemnation against the state of California, against Governor Gage, against the denial of plague.

And some radicals even demanded that the Navy transfer centers be moved north to Seattle.

(cannon fire) Well, this was serious.

San Francisco did not want to risk such a loss of power.

At this point, the denial of plague became costly.

California had run out of options.

It was time to face it, and clean it out, and stamp it out.

(distant shouting) NARRATOR: The responsibility of controlling the plague rested squarely on Blue's shoulders.

CHASE: Blue's boxing taught him how to bob and weave, size up his opponents, anticipating their next move, put an edge on his strategic approach.

NARRATOR: Now, he stared at his map for the hundredth time.

Every single block in Chinatown had had a confirmed case.

♪ ♪ But in the previous September, a white washerwoman with no connection to the district had died of plague, and she lived a block away.

NARRATOR: It dawned on Blue he'd been ignoring something that had been right in front of him the entire time.

The mystery of why the plague had decimated Europe and Asia for centuries was finally beginning to unravel.

(indistinct chatter) CHUCK: For us kids, one of the great pastimes was just fishing off the piers, which ran almost right up against Chinatown.

And ships that were moored to the docks, they had these huge ropes.

You would see rats.

Rats just coming from the ships and coming down those ropes.

And some of them would just fall in the water.

Others were able to find their way onto the docks.

They scurried, they were fast, and they were quick.

(rat squeaking) ♪ ♪ RANDALL: Rats are biological marvels in many ways because they can survive almost anything.

And they can breed incredibly quickly.

(music playing on newsreel) NEWSREEL NARRATOR: And a single pair of rats, left to reproduce unhampered, would become 1,500 in a year.

(rats squeaking) NARRATOR: In his lab, Blue and his men had discovered plague germs in dead rats that they had dissected.

He was now struck by the possibility that rats themselves might somehow spread the disease as they roamed the city, though he still had no idea how.

RANDALL: And he realizes the only way we're going to save San Francisco is if we kill as many rats as possible.

So, they focus on rat eradication.

♪ ♪ NARRATOR: Thanks to Wong Chung's prior outreach, the Chinese Six Companies now agreed that all Chinatown businesses would work with health authorities.

MAN (reading): "People should not be frightened.

"These physicians are very kind and gentle.

Their main emphasis is to go after the rats."

"Chung Sai Yat Po Daily."

CHASE: The state was assigned to hire inspectors.

The city would lay traps and poisoned bait for rats.

And they tried to get all the citizens involved in rat collection.

So they offered 10 cents a rat, even 50 cents for a breeding female.

So, you can imagine this is quite a sum.

And people got involved in bringing in rats.

(rat squeaking) RANDALL: Blue starts to look for where are rats living.

Let's create as few nesting spots for a rat as possible.

Wooden sidewalks provide so many places for rats to nest.

So he rips those out and let's have concrete sidewalks.

♪ ♪ At the same time, let's tear down these remnants of the past, buildings that were still up from the gold rush era.

And let's have more modern buildings in their place.

♪ ♪ NARRATOR: By the spring of 1905, Chinatown was almost completely renovated.

Blue's team was dismantled, its job done, and he was sent to his new posting in Virginia.

With no new cases being reported in over a year, as far as everyone was concerned, the plague was finally under control.

♪ ♪ Out of the official tally of 119 confirmed cases, 104 victims were Asian, and 15 were non-Asian.

RANDALL: I think it's fair to say that the true death toll is probably ten times as much, if not more.

CHASE: It was more than likely the accurate number of plague cases were under-reported because they were entirely racially focused on Asian people.

(horse whinnying) ♪ ♪ (rumbling, crashing) Just after 5:00 a.m., April 18, 1906...

The city was wracked by a massive earthquake.

It would have been 7.9 on the Richter scale, an extremely dangerous earthquake, particularly in a city of unreinforced brick and mortar buildings that simply crumbled.

(horse whinnies) Buildings were pancaked, floors collapsed.

The city was ablaze, water mains were broken.

So, the water reservoirs were not available to fight fires.

In a desperate attempt to stop the advancing flames, the city resorted to setting strategic charges to keep the fire from jumping.

(loud booms) That helped a little bit, but some ne'er-do-wells started dynamiting Chinatown indiscriminately, destroying buildings even further.

♪ ♪ NARRATOR: More than 80% of San Francisco was destroyed, including virtually all of Chinatown.

CHASE: There were 3,000 people killed outright.

Nearly a quarter million injured, hundreds of thousands homeless.

RANDALL: And you had refugees who suddenly have to live in places like Golden Gate Park or other makeshift camps.

CHASE: People were living out of tents.

People were living in a village of earthquake cottages built by the Red Cross.

(thunder rumbling) NARRATOR: The Army and Red Cross handed out crackers and canned milk.

But when word spread that no such aid would be given to the Chinese, the community once again turned to its own devices.

♪ ♪ Four years earlier, merchant Lew Hing had moved away from San Francisco.

QUAN JR.: Lew Hing decided to open a cannery in Oakland, away from San Francisco.

Having been tired of being harassed by the white media, having had to compete against the white canneries that had formed a cartel to try and drive all the independent canneries out of business, and particularly targeted Lew Hing because he had become such a force in the cannery business.

♪ ♪ When the earthquake hit on April 18, the Chinese in San Francisco, they were refused by the white relief agencies and had no place to go.

And so many of the Chinese came to a very small Chinese settlement in Oakland where my great-grandfather, who had some vacant areas around his cannery, he then hired people to cook, and was able to feed thousands of the Chinese who came over.

♪ ♪ NARRATOR: San Francisco was staggering to regain its footing amidst the devastation.

(horse whinnying) And the fallout continued to escalate.

RANDALL: You had instant problems with sanitation.

If you didn't die from the earthquake, or die from the fire, you might die from diphtheria or smallpox or all these other diseases that could rear their head very quickly.

CHASE: With the sewer pipes ruptured, rats, including plague-infected ones, were released into the city to feast on the uncollected refuse, and breed in the ruins.

(rat squeaking) So once again, there was a resurgence of rats and rat-born plague.

♪ ♪ NARRATOR: Thirteen months after the earthquake, San Francisco had its first plague death in three years.

By summer, there were six more.

Wyman immediately wired Blue, and ordered him to return to San Francisco.

CHASE: On this otherwise unassuming residential street in a Victorian house, Dr. Blue set up his new headquarters, and from there, he ran his command center.

(car horn blares) RANDALL: The problem they find very quickly is that plague is no longer a Chinatown problem, it's a San Francisco problem.

♪ ♪ NARRATOR: In stark contrast to the early days, there was now only one Chinese casualty: the president of the Chinese Six Companies.

RANDALL: And that's when Blue starts hearing from white physicians who say, "Perhaps I have seen plague cases before, "and I just thought it was pneumonia.

"Or actually, maybe I knew it was plague and I didn't want to admit it."

And this kind of solidifies for Blue this was a disease of the environment.

SHAH: Now bubonic plague began to emerge in all sorts of different communities across the Bay Area.

And people began to realize that anyone could get bubonic plague.

♪ ♪ NARRATOR: Blue set up a special workplace dedicated to the grisly task at hand.

CHASE: In back of the federal headquarters was an annex to the building that became known as the Rattery.

♪ ♪ And the Rattery was essentially a coroner's lab, a forensic lab, just for rats.

♪ ♪ RANDALL: That's where all the rat carcasses were brought.

And it's just rat after rat that's dissected and opened up and examined for signs of the plague.

And they would chart, you know, what percentage of rats are infected.

(flies buzzing) NARRATOR: By the fall, there were 30 new plague deaths.

Blue and his men stepped up their campaign, killing more than 13,000 rats a week.

(bell ringing) Throughout, he kept trying out new ways to determine how the disease was spreading through the city.

♪ ♪ CHASE: They even took it a step further and tried to analyze migratory patterns.

They wanted to find out where the rats originated and where they traveled.

So, they devised a program that came to be nicknamed the rainbow rats, and they got a group of healthy, active rats and dyed them red, green, or blue, depending upon what district they were from, and turned them loose.

Then they would try to catch them at the other end and find out how they were spreading.

And, of course, when the raucous local press found out, they just had a field day.

♪ ♪ RANDALL: The newspapers mock them for this immediately.

It almost sounds like something out of Dr. Seuss.

And Blue shrinks very quickly from this public mockery.

He's not used to that.

But he continues to try.

NARRATOR: Then a local case caught Blue's eye.

CHASE: There was a physician who had perceived a bad smell in his house.

The doctor decided he would chop out a hole in the wall and get to the source of this unpleasant odor.

And there he found two dead rats.

And immediately, two members of the family got the plague.

♪ ♪ NARRATOR: As Blue pondered the details of this case, he recalled reading a recent report from the British Plague Commission that confirmed the results of a study completed ten years earlier.

CHASE: Pasteur Institute scientist Paul Louis Simond did this experiment.

He put two rats in cages side by side, separated by a grate.

They couldn't touch one another.

One rat was healthy, one rat was sick with the plague.

And Simond made the breakthrough observation that when the plague rat died, the fleas jumped to the side of the healthy rat for their next blood meal.

MAY C. CHU: Bubonic plague is transmitted by Yersinia pestis.

The flea itself is really the host of Yersinia pestis.

And when it seeks a blood meal on its natural host, it regurgitates its bacteria and transmits plague.

And it's only when its own host dies, the flea seeks another warm body, a rat, or if a human comes by, they'll jump on.

It senses that there's something warm here.

"I don't care what it is."

And then they'll bite.

They'll try to feed, because it's hungry.

So, the cause of the transmission between rats and human was the flea.

♪ ♪ NARRATOR: Blue was thunderstruck by the realization that fleas played the primary role in transmitting the disease.

Rats, he now understood, were only agents of the epidemic because of the insects in their fur.

And pieces fell into place: the peaks of the outbreak lined up with the flea's active season.

The baffling on-again, off-again pattern became crystal clear.

SHAH: So, the bubonic plague bacilla was best conveyed by fleas on rats biting humans.

That transmission was the most important thing.

So, the eradication of rats would be pretty significant.

(bells ring) NARRATOR: As the city continued to rebuild, Blue knew that public support for rat extermination was solid.

Still, without full buy-in from the entire community, the stream of rats would continue unchecked.

It was time for extreme measures.

Rupert Blue the strategist understood he needed both a carrot and a stick.

So fleet week was approaching.

But Blue told the city, if the city isn't a healthful place, I will tell the admiral that it's not safe to land his ships.

This was terrible news.

It would be like canceling Christmas, to have the Great White Fleet barred from entering San Francisco, and worse yet diverted to Seattle, the rival city, would have been terrible.

So, all the city had to take part.

♪ ♪ In 1908, the first truly grassroots, fully public, multi-sector health campaign was born.

Educating the populace on simple things like the right way to dispose of garbage.

You have to seal your household and security against rats.

They also educated greengrocers on the right way to store their wares to keep the city streets clean.

And they informed essential nature of sanitary precautions.

♪ ♪ RANDALL: They start putting notices in everybody's mailboxes.

Like, this is what you can do to save yourself and save the city.

CHASE: And little by little, hundreds and hundreds of citizens from all walks of life, churches, temples, lodges, women's clubs, business groups, everyone got on board and did their part.

♪ ♪ NARRATOR: San Francisco got to work.

Long-neglected sanitary infrastructure was rebuilt.

A $4 million bond was issued to renovate the sewer system, and municipal garbage collection and disposal were put in place.

By now, even the local newspapers supported the sanitation drive by publishing the names and addresses of anyone who failed to comply.

In the end, Blue managed to have more than 20,000 houses inspected.

Untold numbers of rats were either trapped or found dead.

But of the ones tested, only 16 were found to be infected.

The outbreak was in retreat.

With backbreaking work, and focused messaging, Blue had finally rounded the corner on the disease.

(water lapping, birds squawking) ♪ ♪ The question that had so long tormented Kinyoun and Blue-- why hadn't the plague taken off exponentially?-- was at last answered.

♪ ♪ CHASE: It's so interesting that we had the germ that was just as lethal as during the Black Death.

The same germ that had ravaged populations in China, and India, what may have saved the city in the end from a much worse disaster was a tiny part of an organ inside of the little flea.

RANDALL: In places where you had this explosion of plague, there was a different species of rat flea.

Its anatomy was slightly different.

It would inject more of the plague bacilli into whatever victim it bit.

In San Francisco, the flea bite would inject a lower dose, harder for it to become a full-blown disease.

So, it was only this quirk of flea anatomy that really prevented millions of deaths in the U.S. ♪ ♪ NARRATOR: February 1908 saw the last diagnosed case of bubonic plague.

For the first time in nearly eight years, San Francisco could afford to celebrate.

And on May 6, 1908, the Great White Fleet sailed into San Francisco Bay.

("Anchors Aweigh" playing, crowd cheering) CHASE: People stood atop every hill and promontory to get a look at these magnificent golden and white ships that were sent by Theodore Roosevelt.

People were waving flags and partying all week.

It celebrated not only the Great White Fleet and naval power, but also the rebirth of San Francisco as a healthful city.

And it was an effort in which everyone had taken part.

♪ ♪ NARRATOR: Chinatown was celebrating its own victory.

Its near-total destruction during the earthquake had lured white speculators eager to snap up the valuable land.

(carriages clattering) But they hadn't counted on the fierce opposition of Chinese merchants and associations, who fought them tooth and nail to control how they wanted the district to be used.

SHAH: We later learn, of course, they were quite successful in turning the fear of Chinatown as a labyrinth of disease and immorality into a kind of middle-class, consumer tourist paradise.

♪ ♪ NARRATOR: On March 31, 1909, Rupert Blue was honored with a lavish ceremony at the Fairmont Hotel on Nob Hill.

♪ ♪ CHASE: The dinner was rat-themed.

They had ice cream molds in the shape of rat traps.

They drank wine punch from beakers that were shaped like little trash cans.

It was kind of visual puns everywhere.

NARRATOR: It was a darkly humorous nod to the rats killed, two million in all, roughly five times the size of San Francisco's human population.

CHASE: And when he was called to the dais to accept his gift and the city's thanks, some of Blue's old shyness came flooding back and he said, "It's difficult to speak when one's heart is full."

After all his achievements, he got rather tongue-tied.

♪ ♪ NARRATOR: It was likely Blue's reticence arose from not just humility, but a clear-eyed view of the debt he owed his predecessor.

True, he had been able to clean up San Francisco and rid the city of its rats.

But Kinyoun was the one who insisted that the problem even existed, and at enormous personal cost.

RANDALL: Blue was seen as a hero, and he continued on 'an upward trajectory.

You know, he became the fourth Surgeon General of the United States.

He was a very forward thinker.

He was somebody who advocated for better treatment of the mentally ill.

He advocated for a national health insurance at a time when that was never heard of whatsoever.

He saw where the world was going.

CHASE: Dr. Joseph Kinyoun's ouster from San Francisco represented a kind of failure of institutional resistance and rivalries.

But he is remembered for bringing state of the art methods of diagnosing infectious diseases to America.

He is remembered for helping found the National Hygienic Laboratory, the forerunner of our modern National Institutes of Health, for which he is posthumously recognized as the first director of NIH.

♪ ♪ NARRATOR: The two men brought an end to the epidemic using vastly different approaches.

Yet, it was the efforts of not just Kinyoun and Blue, but the marginalized community that still managed to stand up for its rights, that led to a paradigm shift in the way America viewed public health.

(fireworks explode, crowd cheers) SHAH: One of the things we learned in San Francisco is that intervention into a disease pandemic is a profoundly political act.

(plane engine roars) Science is one dimension to provide answers and to provide solutions, but it was still subject to human interpretation, human implementation.

McCLAIN: The question that came up in 1900 is what is the balance between public necessity, public health, and individual rights and liberties?

And it was balanced in a terrible way.

CHASE: Power-seeking politicians, and misguided commercial greed that takes precedence over public health, all of that delayed a solution in San Francisco.

In the end, we needed collaboration and cooperation by the federal, state, and local governments, participation by the citizenry, understanding and acceptance of science.

♪ ♪ POWELL: Science is implicated with the larger society.

In San Francisco, we actually pressed science to do work that it has no business doing.

You don't need science to tell us that we should treat people with dignity and love.

Science is a method of inquiry.

It knows a lot, but there's always unknowns.

SHAH: We had some worldviews that were coming into big conflict about how to think about science, about how to deal with a public health crisis, how to not ascribe a racial cause for the disease, and diverting accountability.

But also to think about, is it possible to protect myself from disease?

Is it possible to eradicate disease?

And those are open questions.

♪ ♪ ♪ ♪ ♪ ♪ ANNOUNCER: "American Experience: Plague at the Golden Gate" is available on DVD.

To order, visit ShopPBS or call 1-800-PLAY-PBS.

"American Experience" is also available with PBS Passport and on Amazon Prime Video.

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