It seemed to Mary that no time at all had passed between that utterance and the sensation of Griffin’s penknife scraping her left arm and the dabbing on of some stuff from a glass tube. By her own admission, she had not spoken out; she had not struggled. But she would later testify before a Boston jury that she had been vaccinated against her will and that the vaccine had made her sick. The judge instructed the jury that there was no evidence to support O’Brien’s claim of assault. Hearing the case on appeal in 1891, the Supreme Judicial Court of Massachusetts agreed. To reasonable men of privilege and power—on a bench that included the future Supreme Court justice Oliver Wendell Holmes, Jr.—the young Irishwoman’s legal claim may have seemed absurd. But, O’Brien’s lawyers argued, “a distinction must be drawn between mere submission and positive consent.” In the closed space below the waterline, separated from home and family, the immigrant girl had, by all appearances, passively submitted. Seeing no other exit, she held up her arm to be vaccinated. How many others felt as she did, we will never know.27
In 1891, the U.S. government took control of immigration administration. As it did, the poorer immigrants passed through an increasingly elaborate gauntlet of medical inspection at the nation’s borders. At many American ports, state quarantine officers continued to inspect immigrants, but they did so in compliance with a burgeoning national regime for the processing of aliens. Mass immigration continued unabated, but immigration policy grew increasingly fraught, a battleground for business interests and organized labor, nativists and humanitarians. Global outbreaks of cholera, small-pox, and other diseases kept hygiene central to the administrative process. In laws of 1891 and 1893, Congress assigned the U.S. Marine-Hospital Service responsibility for keeping migrants with contagious diseases from entering the country. Service officers inspected immigrants at port stations from New York Harbor to San Francisco Bay, as well as at designated crossings along the Canadian and Mexican “frontiers.” At a growing number of foreign ports, Service men attached to U.S. consulates inspected immigrant ships before departure, advising steamship companies to refuse passage to those passengers who appeared likely to be turned back for medical reasons upon reaching America.28
U.S. quarantine regulations in force by 1894 made vaccination a prerequisite to entry. Like the older state rules, the federal requirement treated steerage passengers as a class: “All passengers occupying apartments other than first or second cabin shall be vaccinated prior to entry, unless they can show that they have had smallpox, or have been recently successfully vaccinated.” Every steerage passenger bound for America received an inspection card that detailed an elaborate transatlantic process of medical inspection. Boxes on the front of the card recorded the migrant’s passage through inspection by a U.S. consular agent or Marine-Hospital Service officer at the port of departure; through quarantine at the port of entry; and by the U.S. Immigration Bureau. Another box, completed by the ship’s medical officer, called for the passenger’s number on the ship’s manifest list, where U.S. inspectors could find the detailed information on each passenger (including a medical history) required by U.S. law. The back of the card called for an official stamp or signature certifying vaccination. In seven languages, the card warned its holder, “Keep this card to avoid detention at quarantine and on railroads in the United States.”29
A ship entering New York harbor after 1891 first passed quarantine, which remained the province of New York port authorities. The port health officer and his assistants boarded, examining the ship’s manifest and its bill of health—a statement from the U.S. consulate detailing the sanitary condition of the ship and the port of embarkation. The inspectors then searched for passengers infected with any of five quarantinable diseases: smallpox, cholera, plague, typhus, or yellow fever. Smallpox was a constant concern. Unlike the mild form of the virus spreading across much of the country after 1898, the disease making the Atlantic passage was still classic deadly smallpox.30
New York quarantine officials viewed Italian immigrants as a special threat, despite the fact that Italian state medicine had long been in the vanguard of European smallpox control. The Italians had introduced bovine vaccine, and Italian law required all children to be vaccinated within six months of birth and required revaccination for entry into the schools and factory jobs. But none of the nation’s fourteen vaccine-manufacturing establishments could be found south of Rome. And in southern Italy, where most immigrants to the United States originated, vaccination was far from universal. For Dr. Alvah H. Doty, health officer of the port of New York, smallpox arriving on steamships from Naples was a “constantly recurring” problem. Without the quarantine precautions, “a horde of people would be landed on our shores to scatter smallpox broadcast over our land.” It became routine: a huge ship would steam into the harbor, quarantine inspectors would find smallpox aboard, and all of the steerage passengers would be subject to vaccination and detention on Hoffman Island.31
If the New York inspectors found no quarantinable diseases aboard, they left the ship. At that point, physicians of the Marine-Hospital Service’s Boarding Division took over. They gave passengers in the first- and second-class cabins a perfunctory inspection. Rarely was a first-class passenger singled out for closer inspection; and when this did occur, it usually happened not because the passenger looked especially unhealthy, but because some unspecified social marker made him appear out of place. As one officer of the Service explained, “If a passenger is seen in the first cabin, but his appearance stamps him as belonging in the steerage or second cabin, his examination usually follows.”32
When the steamship at last arrived at its destination, a wharf or dock in New York City, only passengers traveling in third-class or steerage were ferried to the federal government’s immigration depot at Ellis Island to run the gauntlet of medical inspectors known, in Service parlance, as “the line.” The inspection at Ellis Island began as soon as the immigrants stepped off the barge. They lined up under the watchful eyes of the medical inspectors, who scanned the crowd for any individual possessing a mental or physical defect. Carrying their baggage, the immigrants climbed the steep stairs to the Registry Room, also known as the Great Hall. Watching from the top of the stairs, Service physicians looked for signs of weakness or heavy breathing that might indicate heart trouble. As the immigrants made their way through the congested gates and cordoned-off areas of the facility, officers examined eyes and scalps, hands and throats, all the while looking for signs that the passenger was unfit to enter the American nation.33
The power to exclude migrants from the political space of the nation—ordering their return to their port of origin, at the expense of the steamship company—was the ultimate power entrusted to U.S. officials at points of entry. The exercise of this authority rested upon the medical expertise of the Marine-Hospital Service officers, who by 1903 inspected nearly 900,000 immigrants each year at thirty-two American ports and several overseas. The power to exclude was not exercised often. In an average year, U.S. officials turned back fewer than 1 percent of all arriving immigrants. But medical criteria, rather than political radicalism or poverty, became an increasingly important reason for exclusion, until it was the principal one. No wonder many recalled those hours at Ellis Island as the longest of their entire journey.34
Immigrants from a smallpox-infected ship, detained in 1901 at the quarantine station on Hoffman Island, N.Y. Photo by Elizabeth Allen Austen. COURTESY OF THE LIBRARY OF CONGRESS
Along the borders with Canada and Mexico, U.S. quarantine law called for aliens to enter only through designated points. Such rules proved difficult to enforce, particularly along the Rio Grande. Many Mexicans, accustomed to traveling freely across the border for work or to visit relatives, viewed the tightening system of inspection around the turn of the century as a violation of their rights. In a single week in February 1899, Acting Assistant Surgeon H. J. Hamilton and his staff at Laredo, Texas, inspected more than 2,500 migrants crossing the Rio Grande via the Laredo Foot Bri
dge, a truss bridge built in the 1880s, or by ferry or train. Most of the people he met at the footbridge insisted upon their “right to pass” without inspection. But that was a privilege the Service extended only to affluent travelers. While the Service routinely inspected all arriving passenger trains from Mexico, checking all second- and third-class passengers for “recent vaccine scars,” inspectors allowed travelers in the Pullman cars simply to swear to their immunity. In his time at the post, Hamilton concluded that the poorer class of Mexicans reckoned smallpox a fact of life and feared vaccination far more than the disease.35
In the winter of 1899, Surgeon General Wyman received a flurry of dispatches from Laredo, a border city of 15,000 people, the majority of them of Mexican descent. Virulent smallpox had raged there for months, with 376 cases and 83 deaths reported in January and February. (The death rate indicates an epidemic of classic variola major.) Hamilton advised the local authorities “to issue some law compelling vaccination, by force if necessary.” In March, Texas health officer W. T. Blunt arrived from Austin. City officials set about fumigating homes, vaccinating, and removing infected residents by force to the pesthouse. The actions targeted the poorer barrios on the east side of town. Meeting strong resistance from the residents, Blunt called in the Texas Rangers. In the ensuing violence, one Mexican American leader was killed, thirteen people were wounded, and twenty-one were arrested. A contingent of the U.S. Tenth Cavalry arrived, and Hamilton took charge of the local vaccination corps. Even with so many soldiers in the area, fifteen residents “had to be reported, arrested, and then vaccinated.”36
Even beyond the nation’s borders, the mark of vaccination became a powerful signifier of American rule. In September 1905, more than 650 black contract laborers from Martinique traveled aboard the French steamship Versailles to Colón, a port city located near the Atlantic entrance to the U.S.-controlled Panama Canal Zone. As the crowded ship approached the port, laborers in canoes paddled up to the ship, warning the passengers that poor treatment and harsh conditions awaited them on shore. The messengers said that vaccination, required of all immigrant laborers by the American sanitary regulations of the Isthmian Canal Commission, would produce “an inextinguishable mark” that would make it impossible for them ever to leave the Isthmus. The migrants refused to leave the ship. The next morning, officials persuaded 500 of them to land. But 150 men remained on board and demanded to be returned to Martinique. A force of Panamanian and Canal Zone police forced the migrants from the ship. According to The Washington Post, “nearly everyone of them had been clubbed, and several were bleeding from nasty wounds.” Many had jumped overboard. Later that same afternoon, all of the laborers were vaccinated, loaded on a train, and shipped out to Corozal, where they were put to work building the canal.37
In the hands of a subordinate people, a rumor can be a surprisingly potent political tool—a “weapon of the weak”—even when the rumor is not true. But the canoe riders of Colón did not exaggerate. In the Canal Zone, only the immigrant workers were compelled to be vaccinated. The doctors uniformly scraped their right arms. Foremen and canal officials used the marks—much as the slave catchers of the remembered past had used brands—to identify and apprehend runaway workers in the Panamanian jungle.38
Watching with dismay as smallpox spread across the American heartland in 1901, Dr. James Hyde of Chicago’s Rush Medical School urged state and local governments to use their full police powers to eradicate this affront to modern civilization. Like many of his professional peers, Hyde found the metaphor of the vaccine scar as passport irresistible. He urged that American governments require this medical mark for entry into the country’s civic spaces. “Vaccination should be the seal on the passport of entrance to the public schools, to the voters’ booth, to the box of the juryman, and to every position of duty, privilege, profit or honor in the gift of either the State or the Nation,” he declared. In one respect, vaccination seemed superior to a printed identity document; this government-certified ticket of immunity was stamped indelibly upon the body. Seasoned health officials did not trust the paper vaccination certificates issued by private physicians; they always asked to see the scar. As one writer noted in American Medicine, “This certain, well-defined sign cannot be forged.”39
That writer was wrong. As health officials and police tightened enforcement of vaccination at public schools, industrial work sites, and railroad depots, Americans started forging scars. Some tried plaster fakes. Others followed recipes printed in unorthodox medical journals and passed along by word of mouth. “Get a little strong nitric acid,” advised the Columbus, Ohio–based journal Medical Talk for the Home. “Take a match or a toothpick, dip it into the acid, so that a drop of the acid clings to the end of the match. Carefully transfer the drop to the spot on the arm where you wish the sore to appear. Let the drop stand a few minutes on the flesh. Watch it closely.” After a few minutes, the skin, stinging, turned red. That meant it was time to blot up the remaining acid. In a week, the nickel-sized spot turned dark. “This sore will gradually heal by producing a scar so nearly resembling vaccination that the average physician cannot tell the difference.” Health officials condemned the “vile crime” as the handiwork of a few antivaccination fanatics. But these intimate acts of civil disobedience were part of something larger, a groundswell of popular opposition to “state medicine.”40
“True compulsory vaccination,” as Health Officer Charles V. Chapin of Providence defined it, aimed to secure general immunity from smallpox by requiring every member of the community to be vaccinated and periodically revaccinated. The model was Germany, which boasted the world’s most vaccinated population and the one most free from smallpox. German law required that every child be vaccinated in the first year of life, again during school, and yet again (for the men) upon entering military service. The U.S. Constitution, as interpreted at the time, foreclosed any serious talk of achieving such a universal system through federal law. That left the matter to the states. Hard political realities—the diversity of state legal cultures, the uneven development of their public health systems, and the suspicion with which many Americans greeted any government interference with their personal liberties—assured that a German-style system of vaccination, covering the entire U.S. population, never came to pass. Most vaccination laws on the books were the residue of bygone epidemics. As the emergencies that begot those laws faded from memory, enforcement waned.41
For all of these reasons, the epidemics of 1898–1903 found many communities poorly protected by vaccination. New circumstances made health officials’ jobs even harder. The advent of a milder type of smallpox and heightened concerns about vaccine safety hindered the efforts of public health officials, who often received little support from lawmakers, government executives, and the public.
Still, when confronted with a costly smallpox epidemic, the same governments that during times of relative health shied away from compulsory measures readily resorted to coercion. The emergency powers they exercised were extraordinary—particularly in thickly populated spaces. In his definitive 1904 treatise The Police Power, Professor Ernst Freund of the University of Chicago Law School covered every form of state regulatory action from liquor licensing to the suppression of labor strikes to trust-busting. But he singled out compulsory vaccination to illustrate the outer limits of legitimate state action. “Measures directly affecting the person in his bodily liberty or integrity,” he wrote, “represent the most incisive exercise of the police power.” During the turn-of-the-century epidemics, millions of ordinary Americans could not enter their work sites, send their children to public school, or travel freely without showing their vaccination scars. To them, the metaphor of the passport seemed real enough.42
Besides soldiers, prisoners, and immigrants fresh off the boat, the most vaccinated members of American society were public schoolchildren. School vaccination rules paved the way for a growing array of measures governing the bodies and behavior of children, as more and more states mad
e school attendance mandatory into the teenage years. By 1902, nearly 16 million Americans—72 percent of all children aged five to eighteen—attended public schools; another 1.2 million went to private schools. The great exception was the South, where most state legislatures had yet to compel school attendance or vaccination. In 1901, only five states had laws on the books requiring universal childhood vaccination in the first year or two of life. But most took measures to keep unvaccinated children from the public schools, especially when smallpox threatened. (Some states, including California and Massachusetts, mandated school vaccination by statute; others, such as New Jersey and Maine, authorized school boards to order vaccination; and in still other states, school boards simply issued orders at their discretion.) Almost everywhere, the requirements applied exclusively to public schools. Parents with the means to send their children to private schools could opt out.43
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