September 1924 On September 28, 1924, in the Macy Street District (present day
Los Angeles Chinatown) of
Los Angeles,
California, a 51-year-old man named Jesús Lajun fell ill with a
fever and a painful lump in his
groin. Prior to the onset of symptoms, Lajun had discovered a decaying
rat under his house and picked it up to throw into the trash. A physician initially diagnosed Lajun's
pneumonic plague as a
venereal disease (sexually transmitted infection), due to his
enlarged lymph node. Even after the Los Angeles City Health Officers' eventual confirmation of the disease as the pneumonic plague, the disease was not referred to by its name. Investigators initially believed that Lajun had contracted the
bubonic plague. Left untreated, the bubonic plague can move to the lungs and cause a secondary pneumonic infection, with a mortality rate of 40–60%. As Lajun's condition worsened, he developed extreme symptoms such as
bloody sputum, causing physician to believe it converted into pneumonic form. Because he was the first with identifiable symptoms of the plague, Lajun was designated the
index patient. Dr. Porter initially diagnosed Lajun's plague as a
venereal disease, or sexually transmitted infection, due to his
enlarged lymph node. Following the Lajuns' diagnosis, they were treated by Lucina Samarano, a pregnant nurse. Samarano lived at 742 Clara Street (Bing Map), which would become the eventual epicenter of the outbreak. However, neither of the Lajuns recovered. Francisca died in an ambulance on its way to
Los Angeles County General Hospital after her symptoms worsened. An
autopsy of Francisca performed by pathologist Webb ruled her
cause of death as
double pneumonia. Jesús Lajun died on October 11, with his cause of death ruled as
bronchopneumonia. Meanwhile, Lucina Samarano developed similar respiratory symptoms and died days later on October 15. No autopsy was conducted on Samarano however, she had been diagnosed as having
acute myocarditis, or
inflammation of the
heart muscle. Samarano was six months pregnant when she first got sick, and delivered a
stillborn baby boy shortly before she died. Her body was returned to her husband Guadalupe Samarano, who later developed infection and died within days. Between October 15 and 19, Father M. Brualla, a
Catholic priest who had administered
last rites to the affected people and held the
requiem mass for Samarano, developed the same respiratory symptoms and died days later, as did several attendants of Samarano's funeral. Many of the Samaranos' friends and family were unknowingly infected by Guadalupe Samarano, On October 22, Guadalupe and Jessie Flores, neighbors of the Samaranos, also fell ill with symptoms of the pneumonic plague and were subsequently hospitalized at the General Hospital. On October 24, physicians again misdiagnosed the Flores with severe pneumonia as there was no known connection at the time between the Flores and Samaranos.''' Flores' body was returned to his family on October 27, exposing them to the bacteria. Afterwards, the hospital's
morgue staff was
quarantined for five days. On October 28, physician George Stevens reported an unknown, highly contagious disease to the hospital and recommended the construction of a quarantine
ward after he and physician Dr. Elmer Anderson both treated patients in unusually critical condition. That same day, brothers Mike and Jose Jiminez also fell ill and vacated 742 Clara Street, the residence of the Samaranos, exposing the rest of the district to the plague.''' A physician also requested an ambulance from the hospital for two patients in critical condition and were highly contagious. Thirteen more cases of an unknown disease were admitted, all of whom developed
cyanosis and
hemoptysis, or bloody sputum, Three of the patients died the same day, and in response the pneumonic plague was first suggested as the cause of the outbreak. The following morning, the diagnosis of pneumonic plague was confirmed by pathologists after an autopsy reported
gram-negative bipolar
staining bacilli resembling the plague. On October 31, the
United States Public Health Service and California State Board of Health learned of the diagnosis indirectly from telegrams sent from the assistant superintendent of the hospital. The telegram was sent to federal and state authorities and medical supply dealers to explore where vaccines or serums to the plague could be found. who often looted from local residents and businesses. The guards ruled vigilantly in the quarantined district and shot stray dogs, cats, chickens, and more in an attempt to eradicate animals that could potentially be plague-infected. of the outbreak and Yersin's request for an antiserum. Brown's transmission was encoded, referring to "pneumonic plague" as "ekkil", "suspected cases" as "suspects", "deaths" as "begos", and "situation bad" as "ethos": and Pomeroy extended the
quarantine to encompass the entire
Macy Street District, The border's boundaries were closed to regular vehicle traffic and guards were positioned at every home with suspected cases. A temporary
laboratory was constructed by the Los Angeles City Health Department in the quarantined area to quickly identify new cases. By this time, the cause of the outbreak had been definitively established as the pneumonic plague. Despite its rapid spread, the outbreak remained largely unknown to the public – information that was released was often falsified or distorted, such as the
Los Angeles Times, which attributed the quarantine to
pneumonia, as opposed to newspapers on the
East Coast which generally covered the outbreak without hesitation. On November 4, 5 more died, bringing the total death toll to 29 (reported as 25 in local newspapers). The newspaper also refuted city officials' claims that the plague outbreak began on October 30. On November 10, the Los Angeles County General Hospital superintendent, N. N. Wood, officially reported 9
clinically diagnosed plague cases after weeks of silence on the plague, which was adjusted to 37 on November 11. == Epidemiology and pathology ==