Our pick of the month, black death at the golden gate, the race to save america from the bubonic plague is the reason we are here this evening. Welcome david randall. [applause] thank you all for coming, especially with the weather outside. It is like to be inside where it is dry. One thing i realized, my first book, when i went and talked about that i realized many people are coming to the talks because they had their own sleep disorders and wanted to talk to somebody about it. This book is about the plague. If you think you have the plague this is not the place for you. There is a hospital three blocks that way, that is where you should go instead. One of the questions people ask me is how did you get interested in this book, the last book i wrote was about malibu. They use to own all of malibu, how they got it, how they lost it. One of the main characters comes up to San Francisco in 1900 and read the letter the bachelors wife, this is the weakest place i have ever seen and there are rumors the plague is here. I was stuck by the word rumors, seemed like one of those things, everybody would know about the outbreak. I started looking into it and learned there was conspiracy between city officials, the governor of california, the states most powerful newspapers to conceal the truth of the plague and by extension put millions of peoples lives at risk. I had never heard of this before and i started realizing this was three stories in one. The story of the disease, of place and people. We can go through all of those. Starting with bubonic plague most people have heard of it because middle school or high school you hear of the plague decimating europe, killing half of the population. It is the same disease, it never went away and what happens when you have bubonic plague is you get a swollen lymph, swollen gland in your armpit that fills with blood so this is where bubonic plague comes from. You typically die within 48 or 72 hours and the longer it stays in your body the bore you die it can change in different forms. It starts with bubonic plague, then becomes septicemia plague which gets in the bloodstream and then finally becomes pneumatic plague, the most violent form of the disease. You can get it just by coughing and this is what decimated europe, people coughing and giving it to everybody else. At the time of this outbreak in the early Twentieth Century there is no cure for the disease and no vaccine. We still have no vaccine now. This starts at the steamship age where the world was connected, people and goods were closely connected, disease could travel faster than ever before. The plague reemerged in china in 1870, started spreading rapidly. It reaches hong kong, decimates the city, hospitals reporting 95 death rate among patients. It kills 10 Million People in china, another 5 million in india, spreads to australia, spreads to scotland and it is only a matter of time before the plague reaches north america for the first time. This is an important thing to realize. This is an era where science and medicine is in its infancy. On the doorstep of the modern age so this is a time doctors, considered a good doctor if you are fast because theres not pain medication or anything else. The idea that science and medicine is something people in weight lab coats do with microscopes and xray machines and Everything Else is still in its infancy, only becoming accepted. This is a time when science is fighting for legitimacy and this is disease no one knows what to do with even though most of the modern age medical understanding of this disease still is not that different from the middle ages. Nothing has changed in 500 years. They just know this is a disease you cant fight, there is no cure and you dont know what to do with. You have on one hand the most terrifying disease in Human History and it is spreading again and where does it spread to . It spreads to San Francisco, which is perhaps the least, the worst place in the world for it to spread and there are many reasons why. Before i go into that, one thing to know when you get the disease, it is a gruesome death. I will read a little bit from the book. This is probably if you are a little squeamish, i learned a lot of very gross things while working on this book. I held back on most of them. If you want to hear the really gross stuff come to me after words and i will tell you. Before plague reached San Francisco it reached honolulu and it was found in chinatown as well. In this scene doctor lee is a doctor in chinatown, the victims name is a boy. The man who brings them is a man named fong. They lived in chinatown. Fong pick some up, put him on his back and walks him to are 3 blocks to the Doctors Office trying to save his life. This is the scene. Doctor lee was alone when fong burst in, the man was covered in feces and vomit and raved and apparent madness. Doctor lee struggled to hold his new patient still, wondering what how he was still alive. A finger to his wrist revealed a racing pulse, the body was facing an internal terror. His for head was so warm to the touch that doctor lee fought the instinct to pull his hand away. His scream sounded wet as if emerging from below the sea. The mans skin which included in the balmy hawaii and son was pocketed with black spots and 4 is leaving the line between bodily tissue and the outside world and unsettled question. The lymph nodes in his thigh was so swollen it looked like his leg been pumped full of air and was at risk of floating away. The mixture of blood and foam began leaking out of his mouth, a sign of ruptured blood vessels. He fell into a coma from which doctor lee knew he would never recover. You have a terrifying disease coming to San Francisco. San francisco at the time was essentially the wild west. San francisco was the most important city in the western half of the country, it was connected through trade, both came through the golden gate before the bridge was there. It could be for russia or hawaii or australia or new york, people going around the horn. This was the Meeting Place of. Still almost a boomtown. This is only 50 years after the gold rush, after statehood, you have people walking San Francisco who were literal gold miners. The mindset of the city was i described in the book as a place that believed in fate rather than skill. Thats what you think the mindset is, you dont mine for gold because you think you are better at mining for gold than anybody else but because you think you can be lucky. I will find the right spot, i will get the biggest market, i will become a wealthy person all of a sudden and if that is your mindset, that you are counting on being lucky, you dont want anybody to get in the way of you becoming lucky. There was no idea you could have Public Health for public goods or the idea you have a civil society. One thing i was struck by in the book, as San Francisco grew, spending on Public Health declined so you have a city with festering problems of a boomtown, a place you lie in the street, people just throw trash and food in the street, expecting rats to take it away. I quote somebody who said god made them scavengers so let them scavenge. That was the mindset. Not only that but San Francisco, everyman type of place, first time hitting its middleage where people cant get jobs as easily as before. They start looking for someone to blame and they find it, in asia it still is. It has 20 of the citys population and like immigrants anywhere chinese are willing to do the jobs nobody else will. On 3, porters in hotels, Everything Else. There is rampant and blatant antiasian bigotry, you look back, it is shocking. The mayor was named james fallon. He runs for the u. S. Senate seat in california. His Campaign Signs say keep california white. That was the focus. A very easy scapegoat for all the problems in San Francisco. The governor at the time was henry gage and like politicians now, he pioneered the idea of calling anything he didnt agree with or anything negative fake news. You have the worst disease in history coming to a place that in no way wants to deal with it, in no way wants to acknowledge it could be in any danger in this is the gateway to the entire country so you have everything ripe for a crisis and a crisis happens. Somebody by the name of juan chuck king, the first known victim of plague in San Francisco, a Health Inspector is writing out the death certificate and does a cursory examination of the body. This is something he hasnt usually done, the same Health Inspector has been fired before for making up causes of death. It is a stabbing wounds, a heart attack, had no idea, he was just writing something down so he looked at the body and he sees a blue bow and jumps back in fear because he knows what it is and knows the danger and knows it could be hong kong, San Francisco could become hong kong very quickly. You have this danger, this disease and you have a people. You have a federal health officer, the Marine Health service, forerunner of the Public Health service today, a man named Joseph Kenyon in San Francisco, hes known as one of the most brilliant doctors in the country. He knows more about plague than anybody else because he studied with the people who worked on outbreaks, in china and india, discovered how plague is spread or the bacterium that causes plague but kenyons problem is he is so brilliant but he almost has a talent at making people hate him. They cant get that knowledge to get to somebody else to get them to trust them and like them and agree with them. The only reason he was in San Francisco in the first place was almost happenstance anyway. He had been in washington and the Surgeon General, somebody write article saying kenyon should be the true Surgeon General because he is bringing the scientific level of the Health Service up to a new level, this drives the Surgeon General crazy with envy. He doesnt want to have any threat to his power so he essentially exiles kenyon out to San Francisco to get him as far from washington as possible so kenyon is here and he is the forerunner of a new era of medicine. He has done this because of personal pain in his own life. His daughter, youngest daughter, has recently died from diphtheria which is one of the most devastating diseases of childhood back then. Now you get shots and vaccines and you are fine but at the time that didnt happen. Kenyon had been so depressed by the death of his daughter that he quit medicine for a while and came back, felt like this was a way out of the pain and studied in germany where they study the first vaccinations and he sees children who are the same age as his daughter receiving shots and recovering as if by magic. In the book i described prometheus has returned and stolen another secret from the gods. It is like magic, how are people surviving. He knows that with medicine people dont have to die and he writes a letter to people back home say every preventable death seems like manslaughter, it weighs heavily on his conscience. He sees plague, he knows what happened and he is paranoid. He knows it only takes one person getting on a train heading east and suddenly you have plague in detroit and chicago and pittsburgh and cleveland and new york and every stop along the way. So much so that there would be no way ever to recover from the disease. The entire country would be ruined. He does what he can and takes drastic measures because he knows it is an emergency. Because of his aggressiveness everybody recoils from him. City and state officials dont want to admit plague is there because it could lead the public panic and could decimate the citys economy. California is the golden state for a reason. People come out here because they think they can find gold or the life of paradise they want. If there is acknowledgment of this plague here everyone will stop coming. The economy will collapse. There is no need or want to acknowledge this disease. The City Health Officials start claiming maybe he is just in this for himself, taking money from city coffers. The Retail Service official doctors who are there, who should be his natural allies want nothing to do with him because they think he thinks he is better than all of them and he does. He makes that known. They dont want anything to do with him whatsoever in the chinese in chinatown on the frontline of the disease, they see his aggressiveness and recoil and start calling him the wolf doctor, this after there is no vaccine, no medicine for plague at the time. There is something, a serum which if you take it, in some studies, in india, it prevents your chance of getting plague by 40 which is not much but it has very obvious and that rental side effects. The body becomes foolish for several days, you have a high fever, you have delusions, you have nausea, body aches and pains, seems as bad as the disease itself. He tried to go through chinatown with Police Officers knocking down doors and injecting people with this. Nobody wants to do it. It causes a riot in chinatown. They start hiding the bodies. He is flying blind, doesnt know where the disease is spreading and because they are hiding the bodies the governor and other people point to kenyon and say you say there is an outbreak, show me the victims and he cant. He knows they are out there but doesnt know where so he found 200 victims of the plague but he thinks there are many more and most likely there is so he goes farther and farther and quarantines the entire state of california, he says nobody can leave the state without a signed paper, this drives everyone insane. State senator stand on the senate floor and says kenyon should behave for this. He has been run out of town and another Public Health officer named rupert blue comes out. Whereas kenyon was thought of as the most brilliant doctor, a little bit crazy, he has been a little bit lazy but what he has going for him is he has this ability to get people to like him and trust him and think of the best San Francisco tech workers, willingness to fail. He looks at things in a different way so kenyon for as brilliant as he is can never get past the idea of race too. Plague is thought of as a racial disease, something only asians can get. So blue starts treating the disease like a real disease anybody can get. He does things that are considered radical. He hires a chinese translator and treated like a full member of staff and builds trust among the chinese whereas kenyon always stayed in his laboratory on angel island, blue opens a laboratory in chinatown itself, walks the streets making connections with people and soon people are starting, the chinese are starting to show him where the bodies are. He is finding victims the kenyon was never able to find and the big mystery, dont want to give away too much, every other place in the world all the other big cities where plague has an outbreak it spread slowly at first and then explodes into the population. It hasnt exploded in San Francisco, something is preventing that. They dont know what it is but it buys time. So blue knows the clock is ticking faster and faster so he starts implementing radical ideas which we now take for granted in terms of public sanitation. He does things like Institute Street sweeping for the first time ever, having cement sidewalk so rats cant burrow underneath it is the first to demonstrate that they knew since the middle ages that rats are associated with plague but didnt know how plague was spread. He demonstrates it is flees on rats that are spreading the disease so he goes and institutes a rat eradication program. Overall he does everything from paying people in nickel a quarter for every rat they bring into him so essentially creates teams of young kids going through the city picking up his many rats as they can like an amateur rat killing squad to he gets a bunch of healthy rats and dies there for different colors, red, blue, green and releases them in the sewer system and puts a flyer saying if you see a different colored rat let us know so this is his only way of trying to track the subterranean passageways through the city and where you should lay traps, where rats are coming and how they are migrating, everything to understand this disease. Because of all this, over time, they kill Something Like 2 million rats in San Francisco which is 5 times the citys population. He contains it in chinatown, is safe enough that he is sent somewhere else to stop the next fire. Then theres the great earthquake in San Francisco in 1906 and now plague has spread everywhere and there were different forms of the disease, the most terrifying is pneumatic. This is what happened. 60 people die in the span of two weeks and not only are people dying quickly but throughout the city now. So half the citys attention, you can no longer say it is a disease of chinatown or immigrants. Now it is from north beach to this neighborhood. It is everywhere. The geography of San Francisco when you think of it from a Public Health perspective is the most terrifying landscape you could deal with. Everything from forest to oceans to skyscrapers to horse stables, everything you can deal with. So lou, through the focus on Public Health is able to contain the disease and one of the big lessons i took from this, diseases are not confined to the past