His denial was based on business reasons, to protect the reputations of San Francisco and California and to prevent the loss of revenue due to quarantine.

[2] Federal authorities worked to prove that there was a major health problem, and they isolated the affected area; this undermined Gage's credibility, and he lost the governorship in the 1902 elections.

[16][17][18] In November 1898, the US Marine Hospital Service (MHS) chief surgeon, James M. Gassaway, felt obliged to refute rumors of plague in San Francisco.

Residents of Honolulu were reporting cases of fever and swollen lymph glands forming buboes, with severe internal organ damage – quickly leading to death.

[22] In this atmosphere of grave danger, January 1900, Kinyoun ordered all ships coming to San Francisco from China, Japan, Australia and Hawaii to fly yellow flags to warn of possible plague on board.

Cargo from Honolulu, unloaded at a dock near the outfall of Chinatown's sewers, may have allowed rats carrying the plague to leave the ship and transmit the infection.

[28] Rumors of the plague's presence abounded in the city, quickly gaining the notice of authorities from MHS stationed on Angel Island in San Francisco Bay, including Chief Kinyoun.

[29][30][31] A Chinese American named Chick Gin, Wing Chung Ging or Wong Chut King became the first official plague victim in California.

[32][33][34] The 41-year-old man, born in China and a San Francisco resident for 16 years, was a bachelor living in the basement of the Globe Hotel in Chinatown, at the intersection of the streets now called Grant and Jackson.

[34] On February 7, 1900, Wong Chut King, the owner of a lumber yard, fell sick with what the Chinese doctors thought was typhus or gonorrhea, the latter a sexually transmitted disease common to Chinatown's residents at that time.

Wilson and O'Brien then summoned Wilfred H. Kellogg, San Francisco's city bacteriologist, and the three men performed an autopsy as night closed.

[23][36] Late at night, Kellogg ran the suspicious samples of lymph fluid to Angel Island to be tested on animals in Kinyoun's better-equipped laboratory – an operation that would take at least four days.

[40] San Francisco mayor James D. Phelan was in favor of keeping the Chinese-speaking residents separated from the Anglo-Americans – claiming that Chinese Americans were unclean, filthy, and "a constant menace to the public health.

Surgeon General Walter Wyman informed the San Francisco doctors at the end of March 1900 that his laboratory confirmed the fact that fleas can carry the plague and transmit it to a new host.

[46] Supportive newspapers, such as the Call, the Chronicle and the Bulletin, echoed Gage's denials, beginning what was to become an intense defamation campaign against quarantine officer Kinyoun.

Secretary Gage agreed, creating a three-man commission of investigators who were respected medical scholars, experienced with identifying and treating the plague in China or India.

Wyman also instructed Kinyoun to inoculate all persons of Asian heritage in Chinatown, using an experimental vaccine developed by Waldemar Haffkine, one known to have severe side effects.

[49] The Chinese Consolidated Benevolent Association, also known as the Six Companies, filed suit on behalf of Wong Wai, a merchant who took a stance against what he perceived as a violation of his personal liberty.

Not quite a class action suit, the arguments included similar wording such as complaints that all residents of Chinatown were being denied "equal protection under the law", part of the Fourteenth Amendment to the US constitution.

In a 1901 address to both houses of the California State Legislature, Gage accused federal authorities, particularly Kinyoun, of injecting plague bacteria into cadavers, falsifying evidence.

[53] Despite the secret agreement allowing for Kinyoun's removal, Gage went back on his promise of assisting federal authorities and continued to obstruct their efforts for study and quarantine.

[56] The extended quarantine of Chinatown was motivated more by racist images of Chinese Americans as carriers of disease than by actual evidence of the presence of Bubonic plague.

[58] The Board then "attempted to sidestep the decision by instituting a quarantine order that avoided mention of race, but which was precisely drafted so as to encompass all of the Chinatown area of San Francisco while excluding white-owned businesses on the periphery of that area"; this effort was also struck down, with the court noting that the boundaries of the quarantine corresponded with the ethnicity of building occupants rather than the presence of the disease.

[59] Upon the death of Wong Chut King, the San Francisco Health Board took immediate action to prevent the spread of plague: Chinatown was quarantined.

In an attempt to avoid a second controversial quarantine, the Health Board continued with a house-to-house inspection to look for possible plague infested households – disinfecting those that were thought to be at risk of infection.

The health board attempted to keep all the information regarding the outbreak secret by implementing strict regulations of what physicians could write official death certificates.

In December 1900 Wyman selected Assistant Surgeon General Joseph H. White to manage the investigation surrounding all of the Pacific Coast stations.

Wilfred Kellogg and Henry Ryfkogel conducted the autopsy and achieved respect from White by revealing that Lung had died from the bubonic plague.

[62] Gage reacted by sending a telegram to President William McKinley urging that the federal experts work with state health authorities.

[62] Countering the continued denials made by San Francisco-based newspapers, reports from the Sacramento Bee and the Associated Press describing the plague's spread, publicly announced the outbreak throughout the United States.