Chapter 2

In Salt Lake City, in 1907, 43 deaths were ascribed to tuberculosis--undoubtedly a broad understatement. And in the face of the ordinance requiring registration of all cases of consumption, only five persons were reported as ill of the disease. By all the recognized rules of proportion, 43 deaths in a year meant at least 500 cases, which, unreported, and hence in many instances unattended by any measures for prevention of the spread of infection, constituted so many separate radiating centers of peril to the whole community.

Why is such negligence on the part of physicians not punished? Because health officials dread to offend the medical profession. In this respect, however, a vast improvement is coming about. Pennsylvania, Maryland, Indiana, Massachusetts, Minnesota, Wisconsin, and other States are not afraid to prosecute and fine delinquents; nor are a growing number of cities, among them Boston, New York, Rochester, Providence, and New Orleans. The great majority of such prosecutions, however, are for failure to notify the authorities of actively contagious diseases, such as scarlet fever, diphtheria, and smallpox.

_"Business Interests" and Yellow Fever_

Epidemics are, nevertheless, in the early stages, often misreported. If they were not--if early knowledge of threatening conditions were made public--the epidemics would seldom reach formidable proportions. But--and here is the national hygienic failing--the first instinct is to conceal smallpox, typhoid, or any other disease that assumes epidemic form. Repeated observations of this tendency have deprived me of that knock-kneed reverence for Business Interests which is the glorious heritage of every true American. As a matter of fact, Business Interests when involved with hygienic affairs are always a malign influence, and usually an incredibly stupid one. It was so in New Orleans, where the leading commercial forces of the city, in secret meeting, called the health officer before them and brow-beat him into concealing the presence of yellow fever, lest other cities quarantine against their commerce. And "concealed" it was, until it had secured so firm a foothold that suppression was no longer practicable, and the city only averted a tremendously disastrous epidemic by the best-fought and most narrowly won battle ever waged in this country against an invading disease.

It is interesting to note, by the way, that this epidemic, with its millions of dollars of loss to the city of New Orleans, might have been averted at a comparatively small cost, had the city fathers possessed the intelligence and foresight to adopt a plan devised by Dr. Quitman Kohnke, the city health officer. New Orleans gets its drinking water from private cisterns. Each of these is a breeding place for the yellow-fever-bearing mosquito. Dr. Kohnke introduced a bill a year before the epidemic, providing for the screening of all the cisterns, so that the mosquitos might not spread abroad; and also for the destruction by oil of the insects in the open pools. The total cost would hardly have exceeded $200,000. But there was no yellow fever in the city then; the public had recovered from its latest scare; and the bill was voted down with derision. I suppose the saving of that $200,000 cost New Orleans some forty or fifty million dollars in all.

Seldom does a Southern State discover yellow fever within its own borders. It is always Mississippi that finds the infection in New Orleans, and Louisiana that finds it in Galveston. This apparently curious condition of affairs is explicable readily enough, on the ground that no State wishes to discover the germ in its own veins, but is quite willing, for commercial reasons, to point out the bacillus in the system of its neighbor. In 1897 Texas was infected pretty widely with yellow fever; but pressure on the boards of health kept them from reporting it for what it was. In light cases they called it dengue or breakbone fever. Now, dengue has this short-coming: that people do not die of it. Disobliging sufferers from the alleged "dengue" began to fill up the cemeteries, thereby embarrassing the local authorities, until one of the health officers had a brilliant idea. "When they die," he said, "we'll call it malarial fever." And as such it went upon the records. Two recalcitrant members of the Galveston Health Board reported certain extremely definite cases as yellow fever. They were forced to resign, and the remainder of the Board passed resolutions declaring that there was no yellow fever, there never had been any yellow fever, and there never would be any yellow fever as long as they held their jobs--or words to that effect. San Antonio also had the epidemic; so much of it that the mail service was suspended; but nothing worse than dengue was permitted to go on the records. Later a Marine Hospital Service surgeon was sent by the government to investigate and report on the Texas situation. He told the truth as he found it and became exceedingly unpopular. Lynching was one of the mildest things they were going to do to him in Texas. And all this time, while Texas was strenuously claiming freedom from the yellow plague, her emissaries were discovering cases in New Orleans that the local authorities there had somehow carelessly overlooked. The game of quarantine, as played by the health authorities of the far Southern States, and played for money stakes, if you please, is not an edifying spectacle in twentieth century civilization.

_Newspapers, Politicians, and the Bubonic Plague_

But if it is bad in the South, it is worse in the West. To-day California is paying for her sins of eight years ago in suppressing honest reports of bubonic plague, when she should have been suppressing the plague itself. That the dreaded Asiatic pest maintains its foothold there is due to the cowardice and dishonesty of the clique then in power, which constituted a scandal unparalleled in our history, a scandal that, with the present growing enlightenment, can never be repeated.

Early in 1900 the first case of the present bubonic plague onset appeared in San Francisco's Chinatown. I say "present" because I believe it has never wholly died out in the last eight years. A conference of the managing editors of the newspapers, known as the "midnight meeting," was held, at which it was decided that no news should be printed admitting the plague. The _Chronicle_ started by announcing under big headlines: "Plague Fake Part of Plot to Plunder." "There Is No Bubonic Plague in San Francisco." This was "in the interest of business." Meantime the Chinese, aided by local politicians, were hiding their sick. Out of the first 100 cases, I believe only three were discovered otherwise than by the finding of the dead bodies. Sick Chinamen were shipped away; venal doctors diagnosed the pest as "chicken cholera," "septemia hemorrhagica," "diphtheria" and other known and unknown ailments.

In May, 1900, came the blow that all San Francisco had dreaded: Texas and New Orleans quarantined against the city, and business languished. At this time two men were in control of the plague situation: Dr. Williamson of the City Board of Health and Dr. J. J. Kinyoun of the Marine Hospital Service. Dr. Williamson and Dr. Kinyoun both declared plague to be present in the city. The business interests represented in the Merchants' Association appealed to Kinyoun to suppress his reports to Washington. In return he invited them to read the law which compelled him to make reports. They then tackled Dr. Williamson, who replied that he'd tell the truth as he found it, and if it was distasteful to them, they needn't listen. They went to Mayor Phelan demanding Williamson's head on a salver. Mayor Phelan stuck by his man. Governor Gage they found more amenable. He issued a proclamation declaring that there was no plague. Governor Gage is not a physician or a man of scientific attainment. There is nothing in his record or career to show that he could distinguish between a plague bacillus and a potato-bug. Nevertheless he spent considerable of the State's money wiring positive and unauthorized statements to Washington. His State Board of Health refused to stand by him and he cut off their appropriation; whereupon they resigned, and he secured another and more servile board, remolded nearer to the heart's desire. Meantime the newspapers were strenuously denying all the real facts of the epidemic, their policy culminating in the complete suppression of plague news. Before this, however, they so inflamed public opinion against Dr. Kinyoun and Dr. Williamson that these two gentlemen became pariahs. Here are a few of the amenities of journalism in the golden West, culled from the display heads of the papers:

"Kinyoun, Enemy of the City."

"Has Kinyoun Gone Mad?"

"Desperate, Kinyoun Commits Another Outrage on San Francisco."

"Board of Health for Graft and Plunder."

"Our Bubonic Board."

One gentle patriot in the State Senate suggested in a thoughtful and logical speech that Dr. Kinyoun should be hanged. This practical spirit so appealed to the Chinese organizations (it was Chinatown that suffered chiefly from the quarantine rigors) that those bodies put a price of $10,000 on Kinyoun's head--not his political head, understand, but the head which was very firmly set on a pair of broad shoulders. Some of the officer's friends went to the Chinese Consul-General and explained unofficially that they would hold him responsible for any accident to Dr. Kinyoun. That personage, supposing that they were suggesting the slow accounting of diplomacy, smiled blandly and said:

"Gentlemen, I sympathize with you; but what can I do?" "Do?" said the spokesman, "Why, you can climb a lamp-post at the end of a rope within one hour of the time that Kinyoun is killed. That's what you can and will do."

The bland smile disappeared from the Oriental's face. He summoned a conference of the secret societies, and the reward for Kinyoun's death was abrogated. Next, the white politicians of Chinatown tried their hand and organized a lynching bee, but the intrepid doctor fortified his quarters, armed his men, and was so obviously prepared for trouble that the mob did nothing more than gather. Arrested twice on trumped-up charges, threatened for contempt of court, he continued to fulfill his duties. Governor Gage and the Republican State Committee now inaugurated a campaign of influence upon President McKinley, which resulted in a Federal Commission, consisting of Drs. Flexner, Barker, and Novy, all eminent scientists, being sent to the troubled city; where, instead of being received with honors, they were abused by the newspapers; insulted by the Governor; and had the humiliation of seeing the doors of the University of California slammed in their faces after they had been invited there. Of course, the Commission found bubonic plague, because it was there for any one to find.

Thus far the United States Marine Hospital authorities had stood back of their men. Now they began to weaken. The findings of the Federal Commission were kept out of the weekly service reports, and data of the epidemic were edited out of the public health bulletins, in disregard of the law. Even this subserviency did not satisfy the California delegation; they wanted Kinyoun out.

And, on April 6, 1901, after a year's brave fight in the face of public contumely and constant physical danger, Dr. Kinyoun was kicked up-stairs into a soft berth at Detroit. He resigned. So the M. H. S. lost a brave, faithful, and able public servant and for once blackened its own fine record.

There isn't space to give the rest of the plague history; how it cropped out in other parts of California; how it was shipped to Matanza, Mexico, and all but ruined that town; how the hated local Health Board, in the face of the Governor of the State, and the Federal authorities, stuck to their guns and won the fight, for San Francisco finally admitted the presence of the plague, and asked for governmental aid. Rupert Blue, one of the best surgeons in the Marine Hospital Service, was assigned to the terrified city, and though he has not been able to wipe out the pestilence, the fact that the smoldering danger has not broken into devastating flame is due largely to his unremitting watchfulness and his unhampered authority. "Business Interests" have had their trial in San Francisco. And San Francisco has had enough of "suppression." To-day the truth is being told about bubonic plague in the public health reports, and, I believe, in the newspapers.

Rochester, New York, one of the most progressive cities in the country in hygienic matters, has established an excellent system of school inspection and free treatment. But the children who most need attention lack it through the carelessness or negligence of their parents. Now, it is this very "submerged tenth" who are set to work early in life. Under the law, the health officer cannot say, "Unless you are sound, you shall not attend school." But there is an ordinance providing that, without a certificate of good physical condition, no child shall be permitted to work in a store or factory. So Dr. Goler refuses these certificates, not only in cases of low vitality and under-nutrition, but for any defect in the applicant's teeth, sense-apparatus, or tonsils, a fertile source of future debility. What is the result? There is a rush of these neglected youngsters to the clinics, and the Rochester schools graduate every year into the world of labor a class of young citizens in splendid physical condition, unhandicapped by the taints which make, not for death alone, but for vice and crime. For the great moral lesson of modern hygiene is that debility and immorality run in a vicious parallel.

As I have said, the most thoroughly organized city department is that of New York City, and this is so because public opinion in New York, taught by long experience that its trust will not be betrayed, is, in so far as it turns upon sanitary matters at all, solidly behind its health department. Hence its guardians work with a free hand.

_Fighting Prejudice and the Death Rate in Charleston_

But what is the guardian to do when the guarded refuse to bear their share of the burden; refuse, indeed, to manifest any calculable interest, except in the way of occasional opposition? Such is the case in Charleston, South Carolina, where every man aspires to do just as his remotest recognizable ancestor did, and the best citizens would all live in trees and eat nuts if they were fully convinced of the truth of the Darwinian theory. Charleston, lovely, romantic, peaceful Charleston, swept by ocean breezes and the highest death rate of any considerable American city; breathing serenely the perfume of its flowers and the bacilli of its in-bred tuberculosis; Charleston, so delightful to the eye, so surprising to the nose!

By accident Charleston got an efficient health officer not long ago. A deserved epidemic of smallpox had descended upon the unvaccinated negroes and scared the tranquil city. Dr. J. Mercier Green was called from private practice to tackle the situation. For weeks he waded in the gore of lacerated arms, and his path through darkest Charleston could be followed by rising and falling waves of Afro-American ululations; but he checked the epidemic, and when three months later the city physician died, he got the place. Now, had Dr. Green been wise in his generation, he would have been content to keep his municipal patient reasonably free from smallpox and live a quiet life. But he straightway manifested an exasperating interest in other ailments. He stirred up the matter of the water supply, regardless of the fact that all Charleston's great-great-grandfather had drunk water from polluted cisterns and died of typhoid as a gentleman should. He pitched into doctors nearly old enough to be his own great-great-grandfather because they failed to report diseases properly. He answered back, in the public prints, the unanswerable Good-Old-Way argument. He opined, quite openly, that there was too much tuberculosis, too high an infant mortality, too prevalent a habit of contagious disease, and he more than hinted that the city itself was at fault.

In the matter of the cisterns, for instance. Charleston now has a good city water supply, fairly free from contamination where it starts, and safely filtered before it reaches the city. But a great many of "our best citizens" prefer their own cisterns, on the grandfather principle. These are underground, for the most part, and are regularly supplied from the roof-drainage. Also, they are intermittently supplied by leakage from adjacent privy-vaults, Charleston having a very rudimentary and fractional sewerage-system. Therefore typhoid is not only logical but inevitable. I have no such revolutionary contempt for private rights as to deny the privilege of any gentleman to drink such form of sewage as best pleases him; but when it comes to supplying the public schools with this poison, the affair is somewhat different. Yet, as far as the Charleston Board of School Commissioners has felt constrained to go, up to date, is this: they have written to the City Physician asking that "occasional inspection" of the cisterns be made, and decorating their absurd request with ornamental platitudes.

With sewage it is the same situation. There is, indeed, a primitive sewer system in part of the city. But any attempt to extend it meets with a determined and time-rooted opposition. The Charlestonians are afraid of sewer-gas, but apparently have no fear of the filth which generates sewer-gas; said filth accumulating in Charleston's streets, subject only to the attention of the dissipated-looking buzzards, which are one of the conservative and local features of the place. I have seen these winged scavengers at work. It is not an appetizing sight. But with one exception they afford the only example of unofficial effort toward the betterment of sanitary conditions, that I witnessed in Charleston. The other came from a policeman, patiently poking with his club at the vent of one of the antediluvian sewers, which had--as usual--become blocked. Yet, despite public indifference and opposition, Dr. Green, without any special training or brilliant ability as a sanitarian, is, by dogged, fighting persistency lowering the death-rate of his city.

There is also a non-medical legislator to whom Charleston owes a debt of unacknowledged gratitude. Mr. James Cosgrove succeeded in getting the Charleston Neck marshes, wherein breeds the malaria-mosquito, drained. Since then the death rate from malaria, which was nothing less than scandalous, has dwindled to proportions that are almost respectable--if, indeed, it were respectable to permit any deaths from an easily destructible nuisance like the mosquito. Nearly all our cities, by the way, are curiously indifferent to the depredations of this man-eater. Suppose, for an example, that Trenton, New Jersey, were suddenly beset by a brood of copperhead snakes, which killed, let us say, two or three people a week and dangerously poisoned ten times that number. What an anti-snake campaign there would be in that aroused and terrified community! Well, that much more dangerous wild creature, the Anopheles mosquito, in a recent year slew more than 100 people in Savannah, Georgia, without arousing any public resentment. And Jacksonville's home brood in 1901 slaughtered 90 of its 30,000 citizens and dangerously poisoned probably 1000 more. New Orleans, by the way, having executed a triumphant massacre of the yellow fever mosquito (stegomyia) is now undertaking to rid itself of all the other varieties. And Baltimore's health bureau has succeeded in obtaining a grant of $10,000 for the purpose of demonstrating the feasibility of mosquito-extermination.

_Killing Off the City Negro_

Throughout the South, figures and conditions alike are complicated by the negro problem. Southern cities keep a separate roster of mortalities; one for the whites, one for the blacks. In so far as they expect to be judged by the white rate alone, this is a manifestly unfair procedure, since, allowing for a certain racial excess of liability to disease, the negro in the South corresponds, in vital statistics, to the tenement-dweller in the great cities. If New Orleans is to set aside its negro mortality, that is; the death rate among those living in the least favorable environment, New York should set apart the deaths in the teeming rookeries east of the Bowery, the most crowded district in the world, and ask to be judged on the basis of what remains after that exclusion. New York, however, would be glad to diminish the mortality in its tenements. New Orleans, Atlanta, Charleston, or Savannah would be loath to diminish their negro mortality. That is the frank statement of what may seem a brutal fact. The negro is extremely fertile. He breeds rapidly. In those cities where he gathers, unless he also died rapidly, he would soon overwhelm the whites by sheer force of numbers. But, as it is, he dies about as rapidly as he breeds. Recent statistics in Savannah, for instance, showed this curious situation:

Excess of births over deaths among the whites, 245.

Excess of births over deaths among the blacks, 10.

Health Officer Brunner has stated the case, in a manner which, I fancy, required no little courage in an official of a Southern community:

We face the following issues: First: one set of people, the Caucasian, with a normal death-rate of less than 16 per thousand per annum, and right alongside of them is the Negro race with a death-rate of 25 to 30 per thousand. Second: the first named race furnishing a normal amount of criminals and paupers and the second race of people furnishing an abnormal percentage of lawbreakers and paupers.

Is the Negro receiving a square deal? Let this commission investigate the houses he lives in; why, in his race, tuberculosis is increasing; why he furnishes his enormous quota to the chain-gang and the penitentiary. Observe the house he must live in, the food that he must eat, and learn of all his environments. The negro is with you for all time. He is what you will make him and it is "up" to the white people to prevent him from becoming a criminal and to guard him against tuberculosis, syphilis, etc. _If he is tainted with disease you will suffer; if he develops criminal tendencies you will be affected._

Will not the white South, eventually, in order to save itself from disease, be forced to save its negroes from disease? It would seem an inevitable conclusion.

_Private Interests in Public Murder_

Always and everywhere present are the private influences which work against the public health. Individuals and corporations owning foul tenements or lodging-houses resent, by all the evasions inherent in our legal system, every endeavor to eliminate the perilous conditions from which they take their profit. For the precious right to dump refuse into streams and lakes, sundry factories, foundries, slaughter-houses, glue works, and other necessary but unsavory industries send delegations to the legislature and oppose the creation of any body having authority to abate the nuisances.