Ironically, some of Kinyoun’s most important undertakings began to bear fruit just as he left the Marine-Hospital Service (MHS). Two months later, on 1 July 1902, Congress expanded the MHS, renamed it the Public Health and Marine-Hospital Service (later the Public Health Service), and formalized and expanded the Hygienic Laboratory into three new divisions with numerous additional personnel (94). On the same day, Congress also passed legislation requiring the standardization of, and federal quality control over, biological products like serums and vaccines (47), an act that recognized a major sphere of activity within the Hygienic Laboratory, and which was later transferred to the yet-to-be-created Food and Drug Administration (FDA). Kinyoun had drafted the first of these acts (31), and had been an insistent force behind the second, ever since the subject had been raised with him by Koch, in November 1894. For almost a decade, these had been two of his greatest passions.
In November 1902, Governor Gage was voted out of office and replaced by a physician. Gage’s farewell address in January 1903 renewed his personal attacks on Kinyoun for “ignorance and vicious conduct,” once again denying that plague had ever existed (95). (Plague denialism in California persisted for several more years.) Seemingly defending his own actions in the plague epidemic as much as Kinyoun’s, whom he virtually never again mentioned by name, Wyman called a 19 January 1903 meeting of 19 state and territorial health officers—the first such meeting in U.S. history—at which he revealed a more volatile situation in San Francisco than had been generally known (96): MHS opponents had taken out a $7,000 contract on Kinyoun’s life (family records say it was $50,000), forcing him to carry a loaded revolver and have an escape launch at the ready. The city of San Francisco had assigned 100 policemen to protect him; at one point the U.S. Army had been called in for the same purpose. During the worst of it, Kinyoun had traveled anonymously, checking into hotels under the name of “Kenar.” The other states countered the actions of California by passing a resolution that viewed “with abhorrence the irretrievable disgrace” of California officials, which constituted a “grave national concern” (97, 98). No American Black Death epidemic ever occurred, but by 1904, 121 plague cases—113 of them (93 percent) fatal—were diagnosed in San Francisco. Health officials believed that many more plague deaths had been concealed, a belief consistent with epidemiological findings: despite almost 100 documented Chinese plague deaths, when compared to pre-epidemic rates, the overall Chinese mortality declined dramatically during the epidemic. Kinyoun’s epidemic reconstructions, based at least in part on an earlier investigation conducted by MHS Surgeon James Morsell Gassaway (1848–1939), later persuaded him that plague had probably been imported into San Francisco as early as 1898 (11). It is now known that California’s flea species (Ceratophyllus fasciatus) has reduced vector competence (the capacity to transmit plague) compared to the classic plague vector Xenopsylla cheopis, and was probably insufficient to cause a massive plague epidemic in the United States. Epidemic plague nevertheless returned after the 1906 San Francisco earthquake to claim even more lives, this time predominantly in white citizens. Moreover, plague escaped into ground squirrels (Otospermophilus [formerly Citellus] beecheyi and other squirrels and prairie dogs) to establish a new American “reservoir” that remains, 112 years later, a continuing public health threat in many Western States.
As Assistant Surgeon General, Geddings became Wyman’s new right-hand man; after 1902, both officers were supportive of the Hygienic Laboratory during a renewed period of growth and development under the productive leadership (1902–1909) of Rosenau. Wyman died of complications of diabetes in 1911. Kinyoun’s uncle, Preston Bailhache, urged Kinyoun to write a book about the San Francisco epidemic. Despite privately penning at least two lengthy and detail-rich letters/documents about it (11, 37), with the promise to write more in the future, Kinyoun apparently went only so far as to suggest that if he did write such a book, he would title it after Victor Hugo’s 1862 classic novel Les Misérables (“the unfortunate ones”), calling it Les Misérables en Quarentaine (11).
After leaving the MHS, Kinyoun went to work for one of the two major pharmaceutical firms then in existence, the H.K. Mulford Laboratories in Glenolden, Pennsylvania (now Merck, Sharp and Dohme), with which he had for several years worked closely to produce and maintain the quality of various biological products (18). Ironically, he returned briefly in 1906 in the role of Hygienic Laboratory “adviser,” as a member of the Society of American Bacteriologists committee helping the MHS standardize tetanus antitoxin (25). After four years at Mulford, Kinyoun wanted a more stable and stimulating life for Lizzie and their children. To that end, he returned to the District of Columbia, to direct its Health Department Bacteriology Laboratory. During the following decade, he worked with MHS and other colleagues on a variety of scientific problems, especially water quality, bacillary dysentery, and hookworm disease in poor Southern children. He developed a safer, more reliable, and widely used smallpox vaccination technique (the “Kinyoun method,” which featured rapid rolling of the needle parallel to the skin surface), with Public Health Service endorsement, before development of the bifurcated needle in the 1960s (99); perfected a stain for Mycobacterium tuberculosis and other organisms (the Kinyoun stain ); and even predicted the future importance of transplanting organs from deceased donors. In later years, he told the story about how on one occasion, when his dairyman failed to show up for several days, Kinyoun—who had been pasteurizing his family’s milk at home since 1893, long before industrial pasteurization was introduced—discovered a milkborne typhoid fever outbreak by investigating the dairyman and five families on his route who had become ill. His civic commitment included a stint on the public order committee of the District of Columbia police force. When a polio epidemic threatened, he quickly went to New York City, then in the grips of a major epidemic, to study prevention approaches that might be applied at home in Washington, DC. He repeatedly stressed the importance of zoonotic diseases (animal diseases that infect humans) (46) and argued for better notification of infectious diseases as a means of better disease control. He became increasingly involved in such progressive community public health issues as basic sanitation and hygiene, tuberculosis control, water safety, meat safety, bread quality, and milk sanitation, taking on a community role similar to what might now be called a “consumer advocate.”
As an elder statesman, he served energetically in many national professional societies, including as Vice President of The American Society of Tropical Medicine [and Hygiene] during its first full year (1904) and as First Vice President of the American Public Health Association (APHA) in 1906. He had also been a prominent leader in the 1894 Convention of [American] Bacteriologists (101), which brought the profession together for the first time. Five years later, the Society of American Bacteriologists (now the American Society for Microbiology) was formed; Kinyoun became its national president in 1909, delivering his presidential address on the future of immunology, in which he discussed the new/evolving idea of two immune compartments, natural and acquired immunity (1). At one point in 1907, he served simultaneously as chairman, vice chairman, or member on four different APHA committees. He was active in many other professional societies, including the American Association for the Advancement of Science and the Association of American Physicians.
In 1908, Kinyoun was elected to the Cosmos Club, whose members included not only prominent medical men like John Shaw Billings and Bellevue-trained colleague William Crawford Gorgas (1854–1920) but also prominent men from other fields, such as inventor Alexander Graham Bell and future U.S. Presidents William Taft (1857–1930) and Woodrow Wilson (1856–1924). He occasionally attended dinner events with sitting U.S. Presidents and Vice Presidents. Lizzie Kinyoun became active in public service groups, such as the Women’s Committee and the Committee of Women of the National Tuberculosis Congress, and her husband was a frequent speaker at such civic events. In 1916, Kinyoun took a three-month leave of absence to become Director of Winston-Salem’s Health Department, returning to Washington after thoroughly reorganizing the department. He and Lizzie were active in Washington’s Temple Baptist Church. Like his father and other male relatives, Kinyoun was a Mason, attending Washington, DC’s Benjamin Brown French Lodge No. 15. His private life seems to have been far from dull. At home, he wrote fanciful stories and verse. For a time he raised two chow dogs—then an exotic breed in America—received from an Asian ship captain, ostensibly to prevent them from ending up on the menu at a Chinese banquet (102). A New York Times story in 1910 attributes to Kinyoun an elaborate theory that ear shape determines musical ability (103). Several newspapers described a more bizarre event. All of her life Lizzie Kinyoun had longed to see her own mother, who had died shortly after childbirth. Nearly 30 years later, she traveled to Centre View (it is unclear whether her husband accompanied her) and had her mother’s“ hermetically sealed” metallic casket dug up and opened. According to The [Baltimore] Sun, Lizzie gazed upon the face of a beautiful young woman who appeared to be still alive (104).
Speaking candidly about the Hygienic Laboratory in 1906, Kinyoun articulated a vision for the future of national public health that echoed some of the notions of men who came to prominence in the 1870s, such as Woodworth and Hamilton. Kinyoun had long spoken in favor of dramatic expansion of the MHS into a powerful national organization taking on all diseases and trying to eradicate those that could be eradicated. In 1906, Kinyoun again and even more forcefully argued for a “national sanitary organization” with a strong research-oriented laboratory core that would not only conduct its own research but also assist the states in research, outbreak investigation, apparently also the control and standardization of biological products, and the prevention and eradication of diseases; in essence, a powerful national organization that would combine the separate functions of what are now the FDA, the NIH, and the Centers for Disease Control and Prevention (31). In a similar proposal in 1910 for a national health department to be directed by a cabinet level secretary (S. 6049), Oklahoma Sen. Robert L. Owen (1856–1947) (1, 105), who was of Cherokee descent, remembered the San Francisco plague events in a speech on the U.S. Senate floor. In defending Kinyoun and the other public health officials who had been on the front lines, Owen stressed the need for a national health entity.