Pox

by Michael Willrich

  One American city tried a very different spatial approach to the fight against smallpox. Like most public health authorities of his day, Cleveland health officer Martin Friedrich believed in compulsory vaccination; it was, after all, national policy in his native Germany. With his gold spectacles and close-trimmed beard, the thirty-six-year-old physician might have been mistaken for Sigmund Freud as he entered cheap lodging houses in the middle of the night and urged free vaccination upon the rowdy bachelors he encountered.65

  In the spring of 1901, mild type smallpox struck the cities along Lake Erie. (More than 1,200 cases would be reported by year’s end, but only 20 deaths.) Friedrich launched a wholesale vaccination campaign concentrated in the city’s immigrant working-class neighborhoods. But four people died of tetanus following vaccination, and many more took ill. With a candor all too rare for a health official of the day, Friedrich announced that the available vaccines were unreliable at best, toxic at worst. “A man would have to have a heart of stone if he would not melt at the sight of the misery it produces,” he said.66

  Backed by the progressive mayor Tom Johnson, Friedrich ceased vaccination and embarked on a different sort of campaign to fight smallpox. He ordered all smallpox patients isolated from the general population. Then he hired a corps of medical students to go house-to-house with formaldehyde generators and fumigate every home in the city. The disinfection campaign took months to complete, but by the end of 1901 it seemed to bring smallpox under control, making the Cleveland experiment national news and Friedrich a reluctant hero of the antivaccination movement. When a physician named J. H. Belt accused Friedrich of “furnishing aid and comfort to the enemy,” the health officer responded that his campaign had won hearts and minds where compulsory vaccination had won only enemies. “A sigh of relief went over the city when I stopped vaccination,” he wrote. “The people began to work in harmony with us, opened their houses for us to disinfect them, gave us all the information we wanted, and helped us in every way conceivable.”67

  For the many contemporaries who applauded Dr. Friedrich’s Cleveland experiment as a more palatable alternative to coercion, time delivered an unsettling rejoinder. Friedrich’s candor about vaccine safety was laudable. His formaldehyde clouds appeared to stamp out the disease, enabling him to duck the most controversial public health issue of his generation—compulsory vaccination. But this dispensation was only temporary. Friedrich’s policy left people unprotected.

  A homeless man from Hoboken, New Jersey, entered the city in May 1902, carrying in his feverish body smallpox of the severest type. As Friedrich said, it was “the smallpox ‘we read about.’” The city launched a sweeping campaign in which more than half the city’s residents were vaccinated through an extraordinary public effort involving civic groups, religious leaders, and the local Academy of Medicine. Chastened but still cautious, Friedrich used the city’s new bacteriological laboratory to test the vaccines on the market for one that was safe and reliable. The vaccination campaign finally stamped out the epidemic by early 1903. But by that time, 246 people lay dead from smallpox.68

  On January 25, 1902, the Philadelphia Medical Journal published an update on Pennsylvania’s smallpox epidemic. The report included the following lines: “At Resetto, an Italian settlement near Bangor, the attempt of the police to bury a woman who died of smallpox, without religious services, resulted in a riot. The Italians seized the coffin, bore it into the church, and then stood guard, chasing the policemen away.”69

  Roseto (as the place was actually called) was a close-knit settlement of fifteen hundred people at the edge of slate quarries in eastern Pennsylvania. The place had recently been named after the hill town in southern Italy from which most of its residents had come. The incident, reported without comment in a leading American medical journal, shows the determination of one immigrant community not to let even the deadly serious matter of smallpox interfere with a proper Catholic burial for one of its members. The people of Roseto rioted. They seized the body from the police. They bore it to a sacred space, their sanctuary. They drove the police from their church and stood guard so that the proper religious rites could be performed. In doing so, they unknowingly contributed a few sentences to a swelling archive of popular opposition to public health authority at the turn of the century—an archive most officials would have agreed showed the ignorance and superstition that hindered their efforts to stamp out smallpox.70

  The power to remove and isolate an infected body—whether dead or alive—was fundamental to public health. “The power of removal,” said Leroy Parker and Robert Worthington in their treatise on American public health law, “is unconditional and unqualified.” But as the tenement mothers of Italian Harlem showed Blauvelt’s vaccination corps, the power was not uncontested. The most common form of resistance was concealment, hiding sick people, sometimes entire families, from public view. When health officials and police went looking for hidden cases of smallpox—sometimes acting on a tip from suspicious neighbors, school officials, or employers—they often walked into a fight. Experienced health officers expected trouble when they came for children. Fathers and mothers responded with tears, fists, and shotguns.71

  Charles Chapin of Providence, one of the more self-reflective public health officials of his era, reckoned that people had good reasons for dreading the pesthouse. For their comfort and survival, smallpox patients desperately needed attentive personal nursing in a healthy environment. A few U.S. cities—including Cleveland, Milwaukee, and the District of Columbia—built permanent smallpox isolation hospitals, modern facilities involving large public investments. Chicago spent the unheard-of sum of $83,000 on its isolation hospital, an elaborate campus of buildings on Lawndale Avenue, complete with electricity and ten acres of well-appointed grounds. But the typical American pesthouse was a crude wooden shed, built in haste and on the cheap. Most lacked plumbing, plaster, or decent furniture. They were located far from their patients’ friends and families, a hard journey over bad roads or, as in the case of Boston and New York, across water to an island.72

  American newspapers were filled with pesthouse scandals. A former patient of the New Orleans pesthouse decried the “horrors” of his confinement in a shanty built upon a swamp. Salt Lake City’s pesthouse was a public “menace.” One survivor of the New York City pesthouse on North Brother Island objected to “the uncleanliness and unsanitary way in which the patients are treated,” calling the “mockery for a hospital” a poor example for its inmates. In 1901, James Kerr willingly surrendered his young smallpox-afflicted daughter to city health officials only to have her die—of tuberculosis—on North Brother Island. Adding insult to grief, the city returned to Kerr the wrong body. As Chapin recognized, the scandalous conditions of many American pesthouses lay behind much of the resistance to removal of “patients.” “It is not to be wondered at that patients and their friends resort to every deception to conceal the disease,” he said, “in order that they may not be carried to such a place.”73

  Improvements to the typical pesthouse came only on those rare occasions when a well-to-do smallpox patient was confined in one. The American pesthouse was, without apologies, a class institution—the medical equivalent of steerage. Pesthouses were designed for the isolation and treatment of smallpox patients who lived in tenements and other dwellings too crowded to allow for their isolation at home. By long practice, affluent members of the community who lived in spacious quarters, at some remove from other dwellings, were entitled to convalesce at home. Health officials who failed to heed this commonly recognized American practice risked litigation and political censure. When Mary Kirk of Aiken, South Carolina, returned from missionary work in Brazil with a case of leprosy, the board of health ordered her removed from her house in the heart of the city to the four-room pesthouse by the city dump. Kirk sued. A “woman of culture and refinement” had no business in the pesthouse, a place “coarse and comfortless, used only for the purpose of incarcerating negroes having smallpox and
other dangerous and infectious diseases.” Awakened to Kirk’s plight, the city council promised to build her a “comfortable cottage” on the outskirts of town, “supplied with all modern conveniences.” Meanwhile, a circuit judge issued an order, forbidding the board from removing Kirk to the pesthouse. Calling this “an exceptional case,” the state supreme court affirmed that action.74

  The poorest members of an American community were not only the ones most likely to be sent to the pesthouse; they were also the people most likely to have one opened up in their neighborhood. Best public health practices called for locating a pesthouse at a safe remove from the local population. Usually, pesthouses were located on the outskirts of town. In some places, state law forbade public health boards to erect pesthouses too close to other dwellings. There seemed to be sound science behind such rules. While most public health officials believed smallpox contagion could not be carried through the air more than two hundred feet without being destroyed by oxidation or dilution, the Journal of the American Medical Association conceded, “This belief is purely empiric; there are no scientific data for its foundation.” In one 1903 study, an English health officer suggested that one “smallpox ship,” a floating pesthouse moored on the Thames, had caused an epidemic in a village half a mile away. As the London Times said, “smallpox hospitals may become sources of serious danger to the unprotected populations in their vicinity.”75

  That sense of danger made a pesthouse, in one medical writer’s estimation, “the most unpopular neighbor that a man could have.” Health officers seeking sites for a new pesthouse were turned back by shotgun-wielding farmers in Durham, North Carolina; writ-bearing “taxpayers” in Omaha, Nebraska; petition-signing citizens in Houston; and blaze-setting residents in Union County, Kentucky. In Bradford, Pennsylvania, three hundred men and women burned down a vacant schoolhouse that local officials had turned into a pesthouse. In Turtle Creek, eight miles outside of Pittsburgh, a “Quaker mob,” two thousand in number, rioted to prevent the board of health from trying the same thing. Firemen turned their hoses on the unruly Friends.76

  Whether the agitators were immigrant laborers or white “taxpayers,” whether they favored the axe or the writ, collective action to keep out the kept-outs had an inherently conservative aspect. These turf defenders did not necessarily object to the pesthouse as a political response to contagious disease. In most cases, their quarrel would evaporate if the government chose another site—somebody else’s backyard. Grievances and interests varied. Property owners feared that a pesthouse in the neighborhood would diminish real estate values. Poor residents protested the endangerment to their health as well as the constant reminder that they lived in their town’s dumping ground.

  In March 1901, two cases of smallpox were discovered in Orange, New Jersey, a city of 24,000 known for its hat-making industry. The board of health hired a builder to construct a pesthouse at the city dump. But the site was surrounded by tenements filled with Italian workers and their families. As the carpenters set to work, a crowd gathered. By evening, 300 angry residents and just two policemen had gathered at the site. The crowd rushed the pesthouse. Someone lit a pile of wood shavings, and within minutes a blaze was making its way toward the structure. Firemen arrived, but a group of the residents stood on their hose, while one tried to cut it with a knife. Clubs flying, the police arrested three men. More police arrived, the crowd was driven back, and the fire was extinguished. The next night, a single pistol shot rang out at the dump. Men carrying axes and crowbars poured out from the surrounding tenements. In a few minutes they reduced the building to splinters. For good measure, a crowd returned later and set fire to the pile of broken wood.77

  In the wake of the incident, the Orange Common Council refused to authorize construction of another pesthouse. The New York Times lamented that the revolt illustrated “the readiness with which well-ordered and generally law-abiding communities revert to barbarism when their fears or evil passions are aroused.” But one letter writer from Orange, a self-described “Sympathizer with the People,” saw justice in the crowd’s actions. “Simply because the residents in the vicinity of the ‘dump ground’ are working people they are to be made uncomfortable and their health and that of their children endangered because the Board of Health—so-called—chose to put a pesthouse up in the midst of their dwellings,” the sympathizer wrote. “Legally, I suppose, the people were in the wrong, but morally they had every right to act as they did.”78

  The altogether ordinary Americans who defied public health measures during the nation’s turn-of-the-century war on smallpox left a deep mark upon the historical record. In their actions rather than their words—which, unlike those of the well-organized, predominantly middle-class antivaccinationists, were rarely recorded—they created a public transcript of opposition to the growth of institutional power in everyday life during the Progressive Era.

  That record of dissent had political consequences. It forced compulsion to show its true self. It emboldened the antivaccination movement. It raised doubts in the heads of some lawmakers and a governor or two. And it even made an impression upon the institutions most removed from the common people, the courts. “It is a matter of common knowledge that the number of those who seriously object to vaccination is by no means small,” observed Justice Orrin Carter of the Illinois Supreme Court, “and they cannot, except when necessary for the public health and in conformity to law, be deprived of their right to protect themselves and those under their control from an invasion of their liberties by a practically compulsory inoculation of their bodies with a virus of any description, however meritorious it might be.”79

  Compulsion engendered resistance even in those tightest of spaces whose inhabitants had no legal claim to liberty at all: prisons and jails. Vaccination was a routine part of penal discipline in the United States, as the young Jack London discovered when he was arrested for vagrancy during his long tramp across North America in the 1890s. London recounted the experience in a chapter of his book War of the Classes (1905), entitled “How I Became a Socialist.” While traveling near Niagara Falls, he was “nabbed by a fee-hunting constable, denied the right to plead guilty or not guilty, sentenced out of hand to thirty days’ imprisonment for having no fixed abode and no visible means of support, handcuffed and chained to a bunch of men similarly circumstanced, carted down country to Buffalo, registered at the Erie County Penitentiary, had my head clipped and my budding mustache shaved, was dressed in convict stripes, compulsorily vaccinated by a medical student who practiced on such as we, made to march the lock-step, and put to work under the eyes of guards armed with Winchester rifles.”80

  For London, living the hobo’s life as a member of America’s “submerged tenth,” the underclass of his day, compulsory vaccination was but one in a litany of injustices that prompted his conversion from a working-class individualist into a socialist and a citizen of the world. During the experience, he said, some of his “plethoric national patriotism simmered down and leaked out of the bottom of his soul somewhere.” In another telling, London recalled with warm solidarity how another inmate, a veteran of the penal system with whom London had shared some tobacco, advised London to “suck it out”—literally to suck the vaccine from his arm. The writer was glad that he did. For afterward he saw “men who had not sucked and who had horrible holes in their arms into which I could have thrust my fist.” London could muster no sympathy for his fellows in prison stripes who had done nothing to stop the state of New York from making its mark on their bodies.81

  “It was their own fault,” he said. “They could have sucked.”82

  SEVEN

  THE ANTIVACCINATIONISTS

  The Medical News gave it a billing worthy of P. T. Barnum: “a smallpox case destined to be famous in the history of the progressive victory of therapeutic science over the ranks of ignorance, prejudice, quackery, and sentimentalism.” A more neutral observer (if one could be found) might have described the entire affair as a case of medical
brinksmanship gone wrong.1

  It had all started with a dare. On November 25, 1901, Dr. Samuel H. Durgin, lecturer in the Harvard Medical Department and chairman of the Boston Board of Health, made a statement to The Boston Globe. “If there are among the adult and leading members of the antivaccinationists,” he said, “any who would like an opportunity to show the people their sincerity in what they profess, I will make arrangements by which that belief may be tested and the effect of such exhibition of faith, by exposure to smallpox without vaccination, be made clear.” Chairman Durgin said he doubted there was “a man or woman among them”—Boston’s small but fervent antivaccination movement—who would accept his challenge.2

  Boston was battling its most serious smallpox epidemic in a generation. The epidemic of 1872–73, Durgin’s first trial as a member of the board, had killed over a thousand people. There was no telling how many would die this time. The first cases, discovered in May 1901 in a Roxbury factory, had killed no one. It seemed that the new “mild type” smallpox, which had been troubling the southern and midwestern states for the past few years, had finally reached Boston. With summer came one small outbreak after another. September brought thirty new cases, October forty-nine, November nearly two hundred. By then, several people had died. With the smallpox hospital on Southampton Street filled to capacity, the board outfitted additional wards at the quarantine hospital on Gallop’s Island, in Boston harbor. According to city physicians, nine out of ten patients turning up at the pesthouses had never been vaccinated. The board opened free vaccine stations around the city. Durgin reached out to Archbishop John Joseph Williams, and his appeal for universal vaccination was read aloud at Sunday services across Catholic Boston. And though the board had yet to issue a vaccination order, hoping to preserve the image of voluntarism for as long as possible, the board’s “virus squad” began its bruising nighttime raids of the city’s lodging houses.3