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New Book Explores Old Epidemic With Striking Parallels to SARS - 2003-04-27

Today's mobile world has led to the rapid spread of the deadly respiratory virus called SARS. But in other ways SARS recalls disease epidemics from more distant times in history. Marilyn Chase is a Wall Street Journal medical writer who sees striking parallels with the bubonic plague epidemic that struck San Francisco, California at the turn of the last century. Taking her title from the city's old waterfront district, known as the Barbary Coast, Marilyn Chase has written "The Barbary Plague: The Black Death in Victorian San Francisco".

The publication of The Barbary Plague comes at a time of mounting public anxiety about SARS, and Marilyn Chase believes that makes her book especially timely. "When I give readings, I often begin by saying, 'Here you have a frightening disease that comes from abroad, that sails across the seas with international travel," she says. "It sounds like it's ripped from today's headlines. But in fact the same thing happened a century ago with bubonic plague in San Francisco."

Bubonic plague is a bacterial disease that breeds in rodents and spreads to humans by the bite of infected fleas. It causes chills, fever, fatigue, and swellings in the lymph nodes. Marilyn Chase says almost 200 people died and nearly 300 more fell ill after the plague struck San Francisco. It was a devastating blow to the former Gold Rush boom town. San Francisco was blossoming into a thriving center of culture and international trade in 1900, when a ship called the Australia arrived in its port. "Plague-infected rats who stowed away in Honolulu, crept off the boat and ran uphill into Chinatown, where it began to infect some of the Chinese residents of the city. The city was not willing to recognize that a deadly epidemic had taken hold. The city fathers took pains to cover it up. There was a conspiracy of silence by the newspapers," she says. "As we've seen throughout history, the existence of an epidemic damages trade. It also affects tourism. So the economic havoc can be considerable."

The outbreak also aggravated ethnic tensions in the city. Many white San Franciscans mistakenly looked on the plague as an Asian disease. A federal quarantine officer named Joseph Kinyoun fueled the antagonisms with his confrontational style, alienating both Chinatown residents and local politicians. The epidemic subsided in 1904. But it broke out again out after a 1906 earthquake forced rats out of walls and sewers and into the open. This time, the crisis was managed by a more diplomatic public health official, Doctor Rupert Blue. "Rather than exacerbating the racial tensions, he tended to calm the situation. He also was able to use some of the emerging knowledge about the way plague really spread," he says. "And he focused on a very rigorous program of rat control and flea control, and eventually persuaded the entire city that if they didn't get on board with this program, they were in fact going to face a ruinous quarantine, and that the whole city would be embargoed by the rest of the United States."

But while the efforts of Rupert Blue finally ended the epidemic in San Francisco, the plague itself wasn't entirely wiped out.

"As a result of the initial resistance by the state of California and the city of San Francisco, the plague had an opportunity to jump from urban rats into rural squirrels and chipmunks, and it moved east towards the Sierra Nevada and beyond," says Ms. Chase. "So plague is still with us. And in fact there are a dozen or so cases of human plague in an average year in the western United States."

The good news is that bubonic plague can now be treated with antibiotics. And there's also a more positive legacy from the San Francisco epidemic. "Not only was it the debut of modern bacteriology, but it was also in many ways the birth of our modern notions of what public health really is," she says. "If you fast forward a century later, when the epidemic of AIDS started striking young gay men, San Francisco became a model of wise public health and compassionate care. So I like to think that during the Barbary Plague, the city gained a certain amount of self knowledge about its own responsibilities to take care of the public's health."

Marilyn Chase believes there are many parallels between the story she tells in her book and other widespread epidemics like SARS. "At first there is often a panicky scramble to find a cause of the disease. Frequently there are disputes over the diagnosis. Often times there is competition between researchers and laboratories. In San Francisco there was a dispute over whether the diagnosis was really bubonic plague," she says. "So you had state doctors coming in issuing false diagnoses of plague deaths as typhoid fever or diphtheria or venereal disease, or anything but plague, to cover it up. And I think the most important parallels we see are this vicious cycle of fear and panic leading to concealment and cover up, and subsequently compounding the problem."

Marilyn Chase says the successes and failures of earlier epidemics point up the need for a public health system that's both alert to new diseases, and ready to cooperate in the search for a cure. "And we saw this work beautifully in the case of SARS. The World Health Organization, the Centers for Disease Control, all worked together in a network of a dozen international laboratories, who communicated daily by means of teleconferencing and e-mail and the Internet to share their diagnoses and their laboratory findings. And it led to an unprecedented victory in identifying this virus, the Corona virus, in record time," she says.

Marilyn Chase is a medical writer for The Wall Street Journal. Her new book is called The Barbary Plague: The Black Death in Victorian San Francisco.

The Barbary Plague was published by Random House, 299 Park Avenue, New York, New York 10171.