From filth to fleas: The third plague pandemic, public health responses, and medical research, 1894-1909

Includes bibliographical references (leaves 88-110)In the late nineteenth century, enabled by improved transoceanic travel, bubonic plague spread from China to every continent. This event took place during a great change in western ideas about disease. Prebacteriological concepts of disease based on location, sanitation, and contagion were challenged by the still-developing germ theory of disease. Public health officials in Hong Kong, Bombay, Honolulu, and San Francisco responded to this virulent threat in different ways depending on local conditions and their understanding of disease. Western officials combined pre bacterial explanations for disease with emerging research produced by bacteriologists. These policies relied on a changing knowledge and acceptance of bacteriology and the means of plague's transmission. The initial results of Western plague control measures were poor, reflecting an inaccurate or incomplete understanding of the disease's transmission. After the turn of the century, research and observations of physicians and scientists in many countries helped develop a new understanding of plague. This was based on bacteriological studies of the disease as well as research into the role of rodents and their parasites in plague's etiology. The ability of public health officials to implement plague control measures depended on several factors. These included political and popular considerations. In San Francisco, commercial and political interests combined to temporarily delay the implementation of plague control operations. In India, an initially aggressive and interventionist program was suspended in the face of rising costs and growing popular unrest. This study utilizes secondary works on the history of medical science, the role of international politics in the development of science, and studies of plague epidemics in each of the four cities. Primary materials came from several sources. A large document collection for the Colony of Hong Kong is available through an electronic database of the Hong Kong University Library. Key documents relating to British plague policy in India have been digitally preserved by Harvard University Library. A United States Senate report provides a valuable narrative of Honolulu's anti-plague campaign in 1899-1900. In addition, a lengthy report by a citizen's committee explores one of San Francisco's confrontations with a plague epidemic. Other primary sources include a large number of medical and scientific journals. These provide insight into the changing state of medical research and provide a guide to current medical thought. In addition, the weekly Public Health Reports of the United States Marine Hospital Service provide statistical as well as narrative evidence of plague epidemics within the United States and abroad