Pox
Page 35
The following year, Immanuel Pfeiffer and the Massachusetts antivaccinationists put several bills before the General Court’s joint committee on public health. All of the bills aimed to repeal the state’s compulsory vaccination laws. All were killed in committee, an outcome the activists may well have anticipated. Antivaccination bills were a more common event in Massachusetts than in Utah. The packed hearings on Beacon Hill had the aspect of ritualized performances: public bouts between old foes who knew each other’s arguments well. But that did not lessen the public drama.
Day after day, committee members and the assembled public heard speeches by health officials (including Chairman Durgin and Dr. McCollom) and doctors from both sides of the vaccination question. Dr. Pfeiffer testified that the board of health’s vaccination stations were places unfit to hold cattle. Dr. Caroline E. Hastings of Boston claimed smallpox tended to increase in proportion to the extent of vaccination in a community. Jessica L. Henderson, a mother from suburban Wayland, vowed she would go to jail before allowing her children or herself to be vaccinated. On the other side, Durgin and his peers paid the antivaccinationists the compliment of taking their campaign seriously. The defenders of compulsion assembled a parade of luminaries from the fields of bacteriology, medicine, and public health to testify against the bills—including Harvard professor of pathology William T. Councilman, Massachusetts Medical Society president Francis Draper, MIT professor William T. Sedgwick, and Azel Ames (who told the committee of his recent experience fighting smallpox in Puerto Rico).73
The antivaccinationists saved their most powerful witnesses for the final day. The bodies of children—present or remembered—were placed, once again, into evidence. The petitioners presented to the committee one “little child whose head was almost one mass of sores.” Mrs. Smith of Winthrop introduced her son Benjamin, who she said had lost the use of his arm following vaccination. Fred W. Hatch of Dorchester said his daughter had suffered a severe case of eczema following vaccination. With the Camden tetanus cases still in the news, Mrs. Caswell of Cambridge told the committee of losing her five-year-old daughter Annie to lockjaw. The death certificate listed tetanus as the cause of death, with vaccination as the contributing cause.74
The antivaccinationists failed to move the committee. At the end of February, the committee adversely reported all of the antivaccination bills, effectively killing them. The following month, the committee favorably reported a new vaccination bill, introduced by Chairman Durgin. The Durgin bill, which was soon enacted by the General Court, made the exemption for “unfit” children from the school requirement more stringent. It required that a physician actually examine the child before signing a certificate. The antivaccinationists had tried to squeeze something for their side from the Durgin bill, submitting an amendment that would extend the health exemption to adults as well as children. But lawmakers rejected it.75
Despite their string of defeats on Beacon Hill, the antivaccinationists had succeeded in keeping the state lawmakers and the public focused on their cause through much of the winter of 1902. The State House debate provided the high political drama of a larger struggle over vaccination that would continue in the streets, the schools, and, increasingly, the courts.
During the next three years, American antivaccinationists won two more legislative victories. In Minnesota, in 1903, Lora Little and activists from Minneapolis and St. Paul placed an antivaccination bill before the state legislature. The bill made it unlawful for any public board to compel the vaccination of any child or make vaccination “a condition precedent to the school attendance.” Dr. Henry M. Bracken, secretary of the state board of health, recalled, “At first this bill hardly seemed worthy of notice on the part of sanitarians.” To his dismay, the House passed the bill. When doctors mobilized in opposition, the Senate amended the bill, adding a clause that allowed boards to require vaccination in the event of an actual smallpox epidemic. Little denounced the amended law as “a disgusting piece of legislative folly.” But health authorities would later complain that the law was all too effective. In 1906, AMA president William J. Mayo, a Minnesota physician, charged that his state’s “inability to enforce vaccination” had unleashed a smallpox epidemic, infecting 28,000 of the state’s citizens—“all due to a small but vociferous band of antivaccination agitators.”76
In California, a crowd of three hundred assembled in Berkeley in 1904 to form an Anti-Compulsory Vaccination Society and protest the “unjust” school vaccination law. The group’s leaders included the president of the local board of education and a local minister. The movement gained traction. In the winter of 1905, the state legislature passed a bill banning compulsory vaccination from the schools. Governor George C. Pardee, a physician, vetoed the bill on March 8, 1905. He cited the “vast preponderance of expert medical authority throughout the civilized world” that viewed vaccination as “the prime cause of the practical disappearance of smallpox.” Pardee insisted that the number of vaccination accidents was “infinitesimal” compared to the “millions of times that this beneficent procedure is practiced.” The legislature let Pardee’s veto stand. In the wake of this political defeat, antivaccinationists in Berkeley announced plans to open a private school, a separatist institution where students and teachers would not be required to show proof of vaccination in order to receive an education.77
From Boston to Berkeley, the vaccination issue revealed tensions at the heart of American public life in the Progressive Era. The conflict pitted scientific authority against democracy, rising government social intervention against an uncompromising individualism, an increasing paternalism in public policy against the rights of parents themselves. Striking communities across the United States with a disease often perplexingly mild, the epidemics brought old debates to a head and provided both sides with new fuel for argument.
For the antivaccinationists, the epidemics provided a welter of fresh evidence. They cited the deaths from smallpox of hundreds of previously vaccinated U.S. soldiers in the Philippines. Martin Friedrich’s Cleveland experiment replaced the antivaccination stronghold of Leicester, England, as the American antivaccinationists’ favorite exhibit in their case for a sanitary approach to smallpox. To the Rivalta, Italy, syphilis outbreak and other Old World examples of vaccination gone awry, 1901 brought Camden—an appalling new American monument to the “victims of vaccination.” The violent clashes between virus squads and working-class populations in innumerable local places provided a powerful public record of the czarist “tyranny” inflicted by public health boards upon the public they were meant to serve.
Lora Little was one of the few American antivaccinationist writers whose vision of the question extended to racial politics. Seemingly alone among her peers, she saw the connection between the bludgeoning of Martinican laborers in the Panama Canal Zone and physical force vaccination in American tenement districts. It was Little, the careful student of newspapers and medical journals, who protested the “brutal invasion” of an African American faith-healing church in Philadelphia by a vaccinating force. “It is time we had a Reconstructed North,” she declared. To Little, writing from her desk in Minneapolis, the routine violence that attended public health enforcement in so many African American neighborhoods showed how far the nation had fallen from “the true idea of freedom and equality before the law which has been the professed ideal of our government.” For Little, at least, the constitutional problem of compulsory vaccination was not just the harm it did to liberty; in practice, the measures also trampled the promise of equal protection of the laws.78
For health officials, too, the epidemics provided a fund of new data and experience. Some were moved to question the practicality of compulsion, convinced by the experience of those years that persuasion might be the better way to achieve their goal of a well-vaccinated community. But others were strengthened in their belief that ignorance was best met with force. From health departments and hospitals across the United States came the evidence: the unvaccinated suff
ered far worse than the well vaccinated. Before the Boston epidemic ended, in May 1903, 1,596 cases of smallpox were reported, with 270 deaths. A majority of the sufferers showed no evidence of previous vaccination. They died at twice the rate of vaccinated patients .79
And so, to their nemeses the antivaccinationists, leading American public health officers and physicians threw down the gauntlet. The dares issued by men like Boston’s Samuel Durgin and Salt Lake City’s Alexander MacLean were born of medical certitude and frustration. To such men, the smallpox epidemics provided many stories of the proverbial chicken “coming home to roost,” as the trusted “fool-killer” smallpox stole the health and lives of a number of committed opponents of compulsory vaccination. In July 1902, The New York Times reported that the well-known Christian Scientist Putnam J. Ramsdell of Cambridge, Massachusetts, had “die[d] of the disease he defied.” In Charlotte, North Carolina, five vaccine refusers died of the disease later that year. In June 1903, on the very same day that the Minnesota legislature enacted the anticompulsion law he had championed, the Minneapolis antivaccinationist Charles Stevens died of smallpox at his home. “Providence seems to have been somewhat against the antivaccinationists,” smirked Secretary Bracken of the Minnesota Board of Health. The Times could barely contain itself when fifteen Dowieites fell ill at Zion City in August 1904. “Now that smallpox has broken out in ‘Zion,’ ” the paper declared, “there is likely to be an excellent, though rather dangerous, opportunity to see what can be done with a disease of that sort by the exercise of ‘faith.’ ”80
But for America’s anti-antivaccinationists, no case of smallpox was sweeter than the one that nearly killed Immanuel Pfeiffer.
The manhunt lasted five days. Only later would the public learn the details of those tense hours. The interrogation of Pfeiffer’s clerk, who insisted the doctor was away in Philadelphia. The interview with the janitor of a Charlestown apartment house, who had seen the doctor, looking weak and accompanied by an unnamed woman, exit by the back door and enter a hack. The search for the hack and its driver, who had taken Pfeiffer and his “companion” (presumed, it appears from newspaper accounts, to be his mistress) to the offices of a certain Boston doctor. The doctor’s denial that he had seen Pfeiffer. The discovery that Pfeiffer and “the woman in question” had engaged another carriage bound for Bedford, the town twenty miles northwest of Boston where Pfeiffer’s wife, Olive, and their children lived on a dairy farm he rarely visited. The health officers’ race to Bedford. The rounding up of the local selectmen. The drive to the farmhouse, where a doctor examined Pfeiffer and declared him “in a very serious condition from a thoroughly developed case of smallpox.” The announcement, by the Boston Board of Health, that Dr. Pfeiffer “probably will not recover.”81
How many had been exposed to smallpox in the days between Pfeiffer’s disappearance and the arrival of the health officials at his Bedford bedside? No one knew. Bedford officials placed the Pfeiffer farm under quarantine, ordering all on the premises vaccinated. Learning that Pfeiffer’s two daughters had been to school since his arrival, officials ordered all the town’s pupils to get vaccinated or stay home. Boston authorities tracked down the two carriages in which Pfeiffer had traveled and disinfected them. All of the residents of the Charlestown apartment house were vaccinated.
To everyone’s surprise (except perhaps his own), Immanuel Pfeiffer’s famous constitution pulled him back from the brink of death, and he began his long recovery. The race for the moral high ground began even before his survival was assured. Durgin announced that several other physicians had visited Gallop’s Island that season, and, having previously been vaccinated, none had come down with smallpox. The Boston Globe dubbed Pfeiffer “a victim of his own zeal and bravado.” The Pfeiffers’ Bedford neighbors took no pity on the man one called an “old chump.” Medical authorities across the nation reminded their publics that the moment was larger than the man. They praised Durgin for his “wisdom and his scientific foresight” in orchestrating this “object lesson” for the American people. Meanwhile, the intended recipients of that lesson—the antivaccinationists—condemned Pfeiffer, too. Boston antivaccinationist B. F. Nichols could find no sympathy for any man “who recklessly exposed himself to contagion.”82
As the days passed, the realization dawned (at least to some observers) that Pfeiffer and Durgin were a dangerous match. The episode showed how far a committed antivaccinationist and an equally determined vaccination advocate would go to make a point. The citizens of Bedford, stuck with a bill of $1,000 for containing the resulting emergency, recognized this better than anyone. Some called for lawsuits against both parties—Pfeiffer, for failing to notify the local authorities of his disease, and the City of Boston for the “inexcusable negligence” of its health authorities.83
In the end, the people of Bedford dropped the matter and moved on. But they’d had a point. Both Durgin and Pfeiffer were true believers who had played Russian roulette with the public health. A jury of their peers, though, might have discerned a difference of culpability between the two men. Pfeiffer believed that vaccination was a sham and that a man of his constitution, psychic power, and cleanly habits was impervious to small-pox; he had, as The New York Times conceded, shown the “courage of his convictions,” however wrongheaded those convictions might have been. Durgin, a sworn government officer of the public health, had staged a public event whereby an unvaccinated man was exposed to smallpox; he had done so with full knowledge of the risks to that man and the general public. Pfeiffer may have been misguided. But Durgin was reckless.
EIGHT
SPEAKING LAW TO POWER
It is one of the more ennobling characteristics of the American system of government that the greatest of constitutional questions may arise in the most humble of places. A coach on a Louisiana train. An elementary school in Topeka, Kansas. A pool hall in Panama City, Florida. The seminal case in modern American public health law began at the threshold of a tenement house apartment in a neighborhood filled with wage earners and immigrants.1
On March 15, 1902, Dr. E. Edwin Spencer, chairman of the Cambridge, Massachusetts, Board of Health, called upon Pastor Henning Jacobson in his apartment at 95 Pine Street, in the neighborhood of Cambridgeport, about a mile east of Harvard Yard. A man little known beyond his Swedish congregation at the nearby Augustana Lutheran Church, Jacobson lived with his wife, Hattie, and their sons Fritz, David, and Jacob. Spencer had practiced medicine in Cambridge for thirty years and headed the board of health for almost ten of them. Spencer informed Jacobson of the board’s “vote” declaring smallpox prevalent in the city and ordering all inhabitants who had not been vaccinated within the past five years to submit to the procedure at once or incur a $5 fine, as provided for by the Massachusetts compulsory vaccination law. The penalty was not trivial: the average weekly wage of an American factory worker was about $13, and it is unlikely that an immigrant minister earned much more than that. Jacobson, forty-five, had not been vaccinated since childhood. Spencer offered to vaccinate him “then and there,” free of charge. But Jacobson “absolutely refused.” He was later summoned to court, tried, and found guilty of “the crime of refusing vaccination.” Rather than pay his fine, Jacobson appealed.2
During the next three years, Pastor Jacobson would pursue his cause all the way to the U.S. Supreme Court, prompting the Court’s first ruling on the subject of compulsory vaccination. In the words of Justice John Marshall Harlan, who wrote the opinion for the majority in Jacobson v. Massachusetts, the minister claimed that “a compulsory vaccination law is unreasonable, arbitrary, and oppressive, and, therefore, hostile to the inherent right of every freeman to care for his own body and health in such way as to him seems best.” More than a century on, it is difficult to appreciate just how radical that claim must have sounded when first uttered. Henning Jacobson was asking the nation’s highest court to contemplate the true extent of constitutional liberty in the United States.3
The Jacobson case marked the
end of the great wave of smallpox epidemics that had swept across the United States at the turn of the century. It also signaled the beginning of the long struggle to reconcile twentieth-century Americans’ ever-increasing expectations of personal liberty with the far-reaching administrative power needed to govern a modern, urban-industrial society.
A man in his prime, with deep-set eyes and a touch of gray in his beard, Henning Jacobson was an unlikely troublemaker. He was an institution builder, the spiritual leader of the Swedish American community of eastern Massachusetts.
Born in rural Yllestad, Sweden, in 1856, he had immigrated to America with his family in 1869. The Jacobsons’ adopted country was in the throes of its post–Civil War Reconstruction and just entering the explosive period of growth that would make it the world’s most productive industrial economy by 1900. As a young man, Jacobson took out naturalization papers and became a U.S. citizen. He studied at Augustana College in Rock Island, Illinois, an institution founded by Swedish Lutheran immigrants in 1860 to prepare young men for the ministry. Jacobson founded the college orchestra. He played the contrabass, anchoring the music with deep-pitched authority.4
Swedish Lutheranism was not a radical religious sect. It was the official state church of Sweden, the faith of the overwhelming majority of Jacobson’s countrymen who migrated to the United States during the peak decades of Swedish immigration after the Civil War. Jacobson received his ordination in Kansas, in the rural heartland of Swedish America. But his future lay in an eastern industrial city. The Church of Sweden Mission Board called him in 1892 to build the Augustana Lutheran Church in Cambridge. He conducted services in his native tongue and became a regular at the Boston docks, meeting newly arrived Swedes and taking them back to Cambridge, where he helped them find jobs and homes. He would remain pastor of the Cambridge church until his death in 1930.