On 27 April 1899, Wyman suddenly transferred Kinyoun to run the enormous 32-building complex of the San Francisco quarantine station, the largest and most complete in the nation, if not the world (37). He replaced Kinyoun as Hygienic Laboratory director with his friend, Milton J. Rosenau (1869–1946). This sudden transfer was part of a general shake-up in MHS assignments involving a number of officers that was undertaken for unknown reasons. Despite appearances, Wyman’s transfer of Kinyoun might not have constituted a lack of confidence in him. The previous year, Wyman had fought the Treasury Department to extend Kinyoun’s directorship while strongly supporting (18) his promotion to Surgeon at the (supposedly) (36) record-breaking young age of 38. (This often-repeated claim of a record-setting youthful promotion is perhaps an exaggeration, as at least one MHS officer, William Henry Marsh [1851–1942], appears to have been promoted to Surgeon before age 35). In addition, plague—the most feared of all pandemic diseases—had been spreading globally for several years. Like most experts, Kinyoun and Wyman believed plague cases would eventually arrive at U.S. ports—especially San Francisco, which received heavy ship traffic from Asian cities with ongoing epidemics—and that only vigilant quarantine could keep the plague out. The horrific ongoing Asian epidemics, which were killing thousands, and remembrance of the 14th century’s Black Death, raised the specter of unimaginable devastation if plague ever reached American shores. Kinyoun had predicted plague’s eventual arrival in the United States as early as 1895, and had begun a plague research program in 1896, which he pursued even more energetically after receiving a strain obtained from China via the U.S. Navy in 1897 (18). Since 1897, Wyman had been writing and speaking about plague as an ultimate test for the MHS. Sending his top scientist to the front lines may have appeared necessary. Subsequent events, however, led Kinyoun to doubt Wyman’s motives, and the issue is clouded by other ambiguities in the puzzling relationship between Kinyoun and Wyman. The prevailing belief among historians is that a troubled relationship between the two men led Wyman to demote his top scientist, a belief consistent with Kinyoun’s later criticism of Wyman and Wyman’s reluctance to ever again mention him by name. But the full facts surrounding Kinyoun’s reassignment and subsequent MHS career remain unknown.
The events that unfolded in San Francisco from 1899 to 1901—still being researched and written about more than a century later—represent one of the most infamous chapters in U.S. public health history (25, 27, 54–77) and the only part of Kinyoun’s life that is somewhat known (albeit filtered through and distorted by the vicious politics, racism, and rampant yellow journalism that colored the era) (68). After a farewell dinner put on by Washington’s medical elite (38, 78), Kinyoun arrived in San Francisco to learn that a “plague ship” was bound from Honolulu. Although Kinyoun found no plague on board, two similar scares followed within the next few weeks. The second of these (4 August 1899) ignited a long simmering feud between California and the federal government (37). Legislation in 1893 had given the MHS authority to work cooperatively with local quarantine officials, an ambiguous situation that most states were happy to accept as long as they received expensive/technically demanding federal quarantine services “for free.” In California, however, quarantine had long become a “states’ rights” issue, precipitating recurring dockside and courtroom confrontations. Wyman’s order to “pay no attention to” (79) California quarantine officials put Kinyoun squarely at odds with combative California Governor Henry Tifft Gage (1852–1924), who threatened the MHS and U.S. customs officials with armed force and lawsuits.
In the middle of these disputes, Kinyoun learned that plague had broken out in Honolulu, making it inevitable that “infected” ships would soon be arriving in San Francisco. In the meantime, he had to handle two smallpox epidemics in U.S. Army troops returned from Manila, suffer four recurrent episodes of appendicitis (11), and inspect hundreds of arriving Asian immigrants for excludable diseases and deformities, an American practice dating back at least to 1700. In December 1900, he would have to make a difficult decision about one such potential Japanese immigrant with a severe hand deformity. For some reason, Kinyoun overlooked this young man’s otherwise excludable condition and authorized his immigration. The man, Hideyo Noguchi (1874–1928), became Kinyoun’s friend and eventually an acclaimed microbiologist. In 1913, Noguchi elucidated the cause of syphilis and, like Walter Reed, would probably have won the Nobel Prize had he not died at an early age.
As the MHS mobilized to control the Honolulu epidemic, Kinyoun began quarantining all arriving vessels from the four current “plague ports”—Honolulu, Sydney, Hong Kong, and Kobe, Japan—simultaneously supporting the Board of Health in “cleaning up” San Francisco’s Chinatown through trash removal, rodenticidal fumigation of sewers and houses with sulfur dioxide—which, unfortunately, tarnished silver, leading to rumors of intentional poisoning, further diminishing the credibility of the MHS—and whitewashing/disinfection of homes by scrubbing with lye or bichloride of mercury. The focus on Chinatown reflected the belief—correct as it turned out—that if plague arrived, it would be imported by Chinese visitors and that most or all cases would be in Chinese visitors or local Chinese residents. Plague epidemiology was poorly understood in 1899, although an association with rats was known and flea transmission postulated. Because plague was a “disease of place,” featuring serial case clusters in one or a few buildings over prolonged time periods, public health efforts focused on identifying “infectious” foci and cleaning them up with disinfection and fumigation, or even burning them down with compensation to owners. On January 20, one such “controlled fire” got out of control and burned down Honolulu’s Chinatown (80), a tragedy that greatly alarmed San Francisco’s 25,000 Chinese residents.
A plague case in San Francisco on 6 March 1900, carefully confirmed by Kinyoun as the first ever on U.S. soil, was national news that caused near hysteria, drawing Kinyoun and the MHS into a fight they were well prepared to meet scientifically but ill prepared to meet politically (54, 81, 82). San Francisco’s mayor and Board of Health immediately placed Chinatown within a police cordon sanitaire, but backed off in the face of legal challenges by a Chinese cultural association allied with California businessmen and politicians. Seemingly everyone got into the fights that followed, with local and national medical and public health experts on one side, and California’s governor, allied politicians, Chinese and Western businessmen, and “muckraking” newspapers on the other. Gage repeatedly accused Kinyoun of malicious intent, declaring plague a ruse concocted by Kinyoun and the San Francisco Board of Health to blackmail the city for public health funds (83). In the California legislature, it was suggested that Kinyoun be hanged (84). As plague cases mounted, control efforts and house-to-house inspections and treatments were thwarted by residents, especially Chinese, who understandably resented being discriminated against. An obscure film shot by C. Fred Ackerman of the American Mutoscope and Biograph Company shows health officials led by a uniformed health officer who was apparently also staging the scene (questionably Kinyoun or another MHS officer), inspecting Chinatown around noon on 15 September 1900, with the camera looking north from Washington Street up Washington Place to Jackson Street (Figure 20) (85). Kinyoun repeatedly advised Wyman against overly stringent public health measures, but nevertheless carried out all orders. Historians have credited Kinyoun with prescience in advising California to concentrate control efforts on killing rats rather than emphasizing quarantine and isolation. On May 15, with 11 indigenous Chinese cases already confirmed and many more hidden cases suspected, Kinyoun, with Board of Health support, declared an epidemic (57, 59).
By this time, Wyman was calling the shots via daily urgent telegrams from Washington, working with Kinyoun to get prophylactic Haffkine serum (a preventive vaccine named after its developer, Waldemar Mordecai Wolff Haffkine [1860–1930]) from his Pasteur-based friend Émile Roux, and obtaining from President William McKinley authorization to implement 1893 interstate quarantine provisions, requiring health certificates for Chinese and Japanese persons within the epidemic zone to travel to other states unless they had been vaccinated. (Some states set up entry restrictions of their own.) Because most Chinatown residents were foreign subjects under the jurisdiction of the State Department, having long been legally prevented from acquiring citizenship, Governor Gage countered by lobbying Secretary of State John M. Hay (1838–1905) to influence U.S. Secretary of the Treasury Lyman J. Gage (1836–1927), Wyman and Kinyoun’s boss, to end the quarantine. (Secretary Gage, unrelated to Governor Gage, was a man who Kinyoun knew intimately enough to refer to as “Lyman” in his correspondence .) Chinese residents got a restraining order in federal district court and brought suit against Kinyoun (86) before William W. Morrow (1843–1929)—a former U.S. congressman and trustee of Washington, DC’s Carnegie Institution, a (later) incorporator of the American Red Cross, and in 1900, U.S. District Judge for the Northern District of California—for ostensibly overstepping federal orders. Bailhache, perhaps better positioned to understand that Kinyoun was being made a scapegoat, urged that he get outside counsel, which he did not (11).
Figure 20. Still image from a 60-second film taken in San Francisco’s Chinatown, midday, September 15, 1900, by C. Fred Ackerman of the American Mutoscope and Biograph Company (85). The film, a paper print, is titled Scene from Chinatown (Library of Congress Paper Print Collection, H30730). The camera is looking North, from Washington Street up Washington Place to Jackson Street. The entire scene appears to have been staged for the camera, and is believed by the Library of Congress to be of a health inspection team. The man in the center of the image (above; a still frame from the film, at 22 seconds) has at this point walked back and forth across the street in front of the camera, obviously directing the film, and later heads toward the camera; he has not been conclusively identified but careful examination and measurements in individual frames indicate that he is bearded and wears a uniform with cap, insignia, buttons, and coat that is consistent with MHS uniforms of the day.
Even so, Kinyoun, fully expecting to be found guilty, was exonerated when honest prosecuting attorneys “switched sides” and petitioned the judge to admit withheld evidence about the nature of his orders, which established his innocence (37). This reversal seems to have coincided with a chance meeting between Kinyoun and Judge Morrow on the ferry to Tiburon (11). By Kinyoun’s account, his off-the-cuff presentation of the facts of the case during this encounter convinced Judge Morrow that he had been duped by the Governor and District Attorney (11), and that Kinyoun was being made a scapegoat by the intentional withholding of key evidence. After Kinyoun’s acquittal, he seems to have maintained a friendship with Morrow, who even requested that Kinyoun help him rat-proof his house using the new rodenticidal “Danysz virus” just obtained from Roux (11). (“Danysz [or Danyz; or Pasteur] virus,” actually the bacterium now known as Salmonella enteritidis, was among the first microorganisms ever employed for biological species control; it remained in use as a rodenticide in Europe at least into the 1950s.)
The national and California medical and public health establishments and most of the national press supported Kinyoun and the MHS; The Journal of the American Medical Association repeatedly editorialized on his behalf. Most of the San Francisco press was scathingly anti-Kinyoun and anti-MHS (Figure 21), calling Kinyoun “stupid and malignant” (87) and repeatedly claiming perpetration of a “plague fake,” even as plague case totals mounted. Among such important issues as state sovereignty, civil rights of minorities, and public health police powers, this was the first time that the authority of microbiology in public decision making had been put on national trial. Wyman now listened to the suggestion of his old friend Welch and called in an outside commission of national bacteriology experts to investigate: Simon Flexner (1863–1946; University of Pennsylvania), Lewellys F. Barker (1867–1943; University of Chicago, who would soon thereafter replace Sir William Osler [1849–1919] at Johns Hopkins), and Frederick G. Novy (1864–1957; University of Michigan) (88), with whom Kinyoun had already begun a scientific collaboration by sending him San Francisco plague isolates and tissue samples (Bentley Historical Library, University of Michigan, Frederick George Novy Collection, Box 1, correspondence; reference 18).
When the commission fully confirmed Kinyoun’s findings (88), Governor Gage and California politicians suppressed the report for several months. Secretary Gage countered with a threat to deprive California of revenue by closing Army headquarters there and diverting San Francisco-bound Philippine transports to Puget Sound if it did not act upon the MHS/ Flexner Commission findings (89, 90). The standoff was finally resolved in the office of President McKinley, with Secretary Gage, Wyman, and Governor Gage’s representatives and with the mediation of California’s U.S. Sen. George Clement Perkins (1839–1923), who had long supported federal quarantine: California would let the MHS take over quarantine and plague control if the MHS removed Kinyoun from his post—via a request for reassignment once the scandal died down—and if California did not have to admit that Kinyoun and the MHS had been right about plague all along, thus remaining free to save face by opposing the Flexner Commission findings even as they allowed the MHS to act upon the Commission’s recommendations (81).
Figure 21. A cartoon from The San Francisco Call (19 June 1900). A sweat-drenched Kinyoun cowers before Judge Morrow, with a guinea pig, rat, and monkey nearby. These animals, which Kinyoun was using for plague isolation, had become cartoon shorthand for the alleged “plague fake.”
One of the Governor’s representatives at that meeting, San Francisco Chronicle editor John P. Young, had allegedly announced before departing that when he returned from Washington, “you would see Dr. Kinyoun’s scalp dangling at his belt”; immediately after Young’s return, Kinyoun was reassigned to Detroit (37).
Kinyoun’s private correspondence reveals a far different picture of his role in these events than most historians have described, claiming that even before he went to San Francisco he had advised Surgeon General Wyman that overly aggressive quarantine enforcement might be unconstitutional and would, in any case, be resisted (11). Kinyoun seems to have viewed Wyman as unnecessarily confrontational when his subordinates were in the line of fire but too quick to compromise at their expense when trouble erupted (11, 37). However, when his advice was overlooked or overruled, Kinyoun seems to have always followed orders to the letter, and to have been willing to accept the consequences, as he did in San Francisco. And he endured seemingly endless accusations, however improbable the claims. When a monkey broke into a hotel room in San Francisco and tore up a photograph of a man’s girlfriend, the dailies accused Kinyoun of letting loose in the city his Angel Island research primates. He never “blew the whistle” on the many instances of questionable, unethical, or illegal practices he witnessed, including attempts to bribe him. Indeed, in comparing himself to the widow in Goethe’s Faust, Kinyoun adopted Mephisto’s role in drily humorous comments about her: “I wonder where she is going when she dies,” he quipped; “I wont [sic] have her. She knows too much” (11).
Governor Gage finally (albeit temporarily) admitted a plague epidemic in San Francisco, but only with the new accusation that Kinyoun had started it by importing plague bacilli and planting them on cadavers (81, 91). Railing against the importation of what are now called “select agents” (81), Gage guided the passage of new laws against what would now be called bioterrorism (California Assembly bill numbers 558, 559, and 560) (81), which were among the first such laws enacted anywhere. In an irony that must have seemed bewildering, on the sad day of Kinyoun’s arranged departure from San Francisco, his public notoriety brought one last tribulation: a charge of attempted murder. A deaf-mute fisherman claimed that Kinyoun, who had once vaccinated him, had directed riflemen to shoot him as he drifted offshore. An arrest warrant was issued; after hiding from authorities by taking sanctuary at an Army installation, Kinyoun finally turned himself in. He was set free when Army testimony revealed that it had been soldiers chasing an escaped prisoner who had fired warning shots at the fisherman, a suspected getaway accomplice, and that Kinyoun had actually intervened to protect him (92). His accuser was unable to identify Kinyoun in any case. Free of courts, jails, and the San Francisco press, Kinyoun left for Detroit on 7 May 1901, after which Wyman allowed him, by prearrangement, a less than urgent trip to Asia to investigate ongoing plague epidemics, visit his old friend Kitasato, and pursue his growing interest in tropical diseases. On his way back, he stopped in the Philippines and codiscovered surra, a new equine disease associated with the previously identified Trypanosoma evansi.
It had been Kinyoun’s desire to stay in the MHS, finish his work in San Francisco, and be vindicated, but this hope was not to be realized. Having been sacrificed for the good of the MHS and public health in general, Kinyoun felt that honor required him to resign. (The entire MHS officer corps supported Kinyoun in his trials; his close friend Henry Rose Carter pleaded against resignation: “Don’t do it, old man. You are one of the men who helped make this service . . . Believe me . . . your life and good works will never be lost” ). Citing a “crusade” against him by California politicians, the Journal of the American Medical Association editorialized: “Dr. Kinyoun’s offense was that he simply told the truth, and did not actively go to work to suppress it” (93). But on 1 May 1902, just as plague was making another comeback in San Francisco, Joe Kinyoun became a private citizen. It was, briefly, national news, and among the last times his name would be linked publicly to anything other than endless retellings of the San Francisco scandals. That the events that unfolded in San Francisco troubled him and left him defensive and perhaps embittered is clear from the two lengthy documents he wrote about it (11, 37). Perhaps he took some comfort in remembering what George M. Kober (1850–1931) had said about him at his honorary dinner in 1899: that no one “has contributed more to the reputation of the Marine Hospital Service and helped to place it on a higher scientific plane,” adding that “men of this type are rare in this world” (38). He may also have taken some comfort in the outpouring of national support from the medical and public health communities and much of the general public, and from most of the respected California medical community such as John M. Williamson, M.D., President of the San Francisco Board of Health, who wrote of him: “[he] was brutally maligned and scandalously misrepresented by persons desirous of making political capital” (81). A colleague noted that Kinyoun “was more proud of and devoted to” the Hygienic Laboratory than anything else (36). In his parting comments about the Hygienic Laboratory to Bailhache, Kinyoun reflected in 1901 that: “. . . it was through my efforts that the hygienic laboratory was established. My 15 years of work stands for this, and I believe that I can point to it with a little . . . pride . . . There is only one thing [no one] in the Marine Hospital Service can take from me, and that is my professional standing and character” (37). Yet perhaps reflecting on nearly two years worth of remarkable and often outrageous events in San Francisco, in the end he could muse: “It was really a tragic occurrence, but all tragedies are tempered with comedy” (37).