Review of Marriott, The Plague Race

Edward Marriott, The Plague Race: A Story of Fear, Science and Heroism. Picador: Basingstoke, 2002

The Plague Race is a short and very readable account of the 1894 race between the French microbiologist Alexandre Yersin and his Japanese colleague and competitor Shibasaburo Kitasato to discover the organism responsible for the bubonic plague.

In the summer of 1894, Hong Kong was in the grips of the third worldwide epidemic (or pandemic) of the bubonic plague, which was devastating the island's notorious slum quarter. The local health authorities were unable to cope with the rising death toll and the colonial government issued a call for help. Two of the finest microbiologists of the day responded: Shibasaburo Kitasato arrived on 12 July and Alexandre Yersin a few days later on 15 July.

Yersin rose from a humble background in Switzerland to a promising career at the Pasteur Institute in France. But suddenly he dropped out and left for the French colony of Indochina. When the call reached him, he was active as an explorer and a microbiologist in Vietnam.

Kitasato was born in 1852 on Japan's southern island of Kyushu. He distinguished himself first as a dedicated student and then a scientist. He was chosen to study under the brilliant microbiologist Robert Koch in Berlin, where he discovered the organism responsible for tetanus. After 6 years in Germany, he returned to Japan in 1892.

From there a tale of a battle on a far from even playing field unfolds. Kitasato arrived in Hong Kong with a team of specialists and a large cargo of equipment, was received with all honours by James Lowson, the Superintendant of the Chief General Hospital and a member of the colonial elite. Lowson provided Kitasato with work space in the hospital and access to bodies for sampling and autopsies (though this had to be kept secret because of Chinese religious concerns). The professor was quartered in a comfortable hotel.

By contrast, Yersin only had two servants in his company and a mere suitcase full of equipment. He was virtually ignored by Lowson and eventually decided to build a grass hut that served as his home and research facility. To obtain specimens, he bribed the British sailors who carried and guarded the bodies. Kitasato and Yersin met briefly but once. They did not hit it off and then worked separately from each other.

Yersin quickly becomes the underdog in Marriott's narrative and one cannot help but root for him. Marriott skews the perspective early in the book by introducing the somewhat ambivalent character of Lowson, a gifted man in his own right but aslo given to colonial snobbery. To the extent that this tale can have a villain, Lowson fits the bill. Kitasato's official stature and appearance suited Lowson's taste, the loner Yersin obviously did not. From there, the tale moves towards Yersin's triumph as the discoverer of the plague. His acclamation was only delayed by Kitasato's posturing and Lowson's connivance.

The main story of the book is interspersed with a fictional account of the 1994 plague epidemic in Surat, India, current WHO plague control efforts in Madagascar (presently the country with the highest plague mortality in the world), the arrival of the plague in San Francisco after 1900 during the same pandemic that had visited Hong Kong, and attempts at rat control in present day New York.

Each of these subsidiary strands has an interest of its own and they certainly are a grim reminder that the plague is still with us in large parts of the world. It colonized western North America in the early 20th century where it found a ready reservoir in the ground squirrel and prairie dog populations. It did not reach the east but in New York and other large cities a large potential reservoir exists in the form of huge rat populations that can at best be checked but not exterminated by the piecemeal efforts employed against them.

Undoubtedly, these strands add value for readers to whom the topic of epidemics is less familiar and implicitly make the case that functional public health systems remain an essential public service in the face of emerging and re-emerging diseases. However, I found they somewhat distracted from the main story.

A more serious concern with the book is that despite the topic, the actual microbiological content is quite thin. There is little to tell what the problem with Kitasato's culture was. A suggestion early in the story is that Kitasato and his allies did not sample from the bubos of plague victims (p. 99) and that they did not extract a pure strain (pp. 99-100):

...invited by Kitasato to look through the microscope, he [Yersin] saw not only the typhoid bacilli that Kitasato had claimed were there but smaller, scarcer bacteria.

The issue of Kitasato's culture is never resolved because Marriott almost loses sight of Kitasato as he follows Yersin to his discovery and victory. That Yersin was denied full credit for his discovery is attributed to Kitasato and Lowson's skilfull manipulation of publicity through their dispatches to the Lancet. Kitasato's supposed discreditation is handled in equally sketchy terms with only vague references rather than a proper and probably illuminating account of this part of the story.

More importantly, the case for Yersin's victory is far less clear cut than Marriott makes out. He would have done well to consider the arguments of David J. Bibel and T. H. Chen, "Diagnosis of the Plague: an Analysis of the Yersin-Kitasato Controversy," Bacteriological Reviews 40: 633-651, 1976 in his book (available at http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=413974&blobtype=pdf). Bibel and Chen carefully compare the available evidence. They conclude that the differences in the early descriptions of Yersin and Kitasato's cultures were minor and within the range of variance one might expect between teh descriptions of independent researchers. They also believe that Kitasato's methods were mostly sound given the state-of-the-art in the 1890s. Many methods, even the common Gram stain, were far from standardized at that time, which could lead to confusion in classifying a bacterium as gram positive, negative or variable. Sampling blood for the bacterium, Kitasato's preferred method, was recommended practice at the time when Bibel and Chen wrote. Also, plague bacilli are notoriously pleomorphic, i.e., they appear in a number of shapes. All this adds up to a degree of uncertainty both for researchers in the 1890s and later authors when trying to interpret the writings of their predecessors.

Bibel and Chen believe that Kitasato discovered the correct organism but that his culture eventually was contaminated by pneumococci. They believe that Kitasato did not admit his error publicly because he feared it would damage his career and conclude (p. 648):

From our analysis we are confident that Kitasato had examined the plague bacillus in Hong Kong during late June and early July 1894. For the most part, his report was an accurate description of teh bacterium, and the document alone was sufficient for Western scientific circles to give Kitasato a share in the discovery....It is only because of the similarity of the plague bacillus to the pneumococcus under specific but common conditions that Kitasato was lead to subsequent error and doubt....Nevertheless, the contribution of Kitasato to the diagnosis of the plague and its history is significant, and this work will endure.

According to their account, Kitasato's cultures were distributed and analysed by other researchers. It would be interresting to know what happened to them. It appears then that Marriott's attempt to award the victory to Yersin alone as the discoverer of the plague organism is unwarranted since he does not discuss the underlying microbiology.

Despite these reservations, I recommend Marriott's book because of its portrait of the enigmatic Alexandre Yersin, its account the field working conditions early epidemiologists laboured under, and the thrill of watching scientific research in action.