Pox

by Michael Willrich

  Even so, the long-gone epidemics that swept across the United States over a century ago hold important lessons for us. In our post-9/11 moment, civil libertarians have dusted off the Jacobson decision, finding in that complex opinion a set of useful standards for balancing governmental power and individual rights during a health emergency. The experience of those historical epidemics also underscores the abiding importance of public education and political candor in matters affecting personal health. People care deeply about their bodies. To ask them to accept the risk of bodily harm for the sake of others is at times essential. But the decision to make that request of the people has the greatest prospect of success when it is made with the care and public deliberation worthy of a democratic society.

  In a broader sense, the history of America’s turn-of-the-century fight against smallpox cautions us against making reflexive judgments about the innumerable people, the world over, who greet scientific innovation and expert authority with skepticism, resentment, or steadfast resistance. To dismiss so many people as merely ignorant and irrational is worse than intolerant. At a time when the ability of democratic nations to promote the security and health of their citizens depends ever more on science, it is the purest folly. It tells us little about the root causes of ambivalence toward medical science or how to bridge the gap between popular beliefs and the imperatives of preventive medicine. Scientific innovations that in hindsight seem manifestly rational, benign, and inevitable often appear far more problematic to people on the ground. Unthinking scientific triumphalism is no sounder an approach than antiscientific denialism to the social conflict and political contention that are likely to continue to haunt the human quest to make ours a healthier world.

  Acknowledgments

  Generous fellowships and grants underwrote this project. The Radcliffe Institute for Advanced Study at Harvard gave me a full year to do the initial research and furnished a marvelous setting in which to do it. I am immensely grateful to Radcliffe, to the brilliantly diverting Fellows Class of 2004–5, and especially to Drew Faust and Judy Vichniac for the gift of that year. I am also deeply grateful to the American Council of Learned Societies for the Charles E. Ryskamp Fellowship (named for a warm and generous scholar no longer with us), which bought me a full year of writing time and other support. Brandeis University provided a semester of leave time on each end of this project, as well as smaller grants to cover costs, for all of which I give thanks.

  I owe a special debt to four exemplary historians who wrote in support of my fellowship applications: my mentor Kathy Conzen, Tom Haskell, Jackie Jones, and Laura Kalman. I hope this book repays your confidence in some small way.

  Along the way, I presented pieces from the project to workshops and audiences at the American Society for Legal History, Boston College, Boston University, Brandeis University, Canisius College, Cleveland State University, Harvard University, Johns Hopkins University, New York University, Stanford University, the University of Minnesota, the University of Nevada, Las Vegas, the University of Pennsylvania, the University of Wisconsin–Milwaukee, the University of Virginia, and Yale University. I want to thank my many hosts for their hospitality and the members of those audiences for their challenging comments. Ironically, a bout with the H1N1 flu virus (before I had a chance to get vaccinated) forced me to cancel a presentation at the University of Michigan, but I am grateful to Tom Green, Bill Novak, and their legal history students for sending me such crisp comments on my paper. A line here and there in this book first appeared in my article “‘The Least Vaccinated of Any Civilized Country’: Personal Liberty and Public Health in the Progressive Era,” Journal of Policy History, 20 (2008): 76–93; I wish to thank the journal for permission to use that material here.

  I also want to thank Ann Mary Olson, who provided excellent research assistance during my year at Radcliffe; and Fred Turner, who did some helpful digging for me in the Spooner Papers.

  A great many friends and colleagues read pieces of this project along the way or heard me out as I worked through my ideas in conversation. For their insights, research leads, and camaraderie, I particularly want to thank Brian Balogh, Norma Basch, Mary Bilder, Henry Bolter, Chris Capozolla, Andrew Cohen, Tino Cuellar, Jane Dailey, Matt Daniels, Michele Dauber, Peter Garlock, Patsy Gerstner, Julian Go, Bob Gordon, Sally Gordon, Hank Greely, Rob Heinrich, Daniel Hulsebosch, Robert Johnston, Michael Katz, David Kennedy, Daniel Kosoy, Dan Kryder, Gerry Leonard, Jill Lepore, Kenneth Levin, Charlie Lord, Rob McGreevey, Harry Marks, Bill Novak, Robert Orsi, David Rabban, Heather Richardson, Elizabeth Sanders, Dennis Scannell, Mark Schmeller, Bruce Schulman, Daniel Sherman, Lindsay Silver Cohen, Ross Silverman, Jonathan Stapley, Tom Sugrue, David Tanenhaus, Geoff Tegnell, Chris Tomlins, Barbara Welke, John Witt, Rich Young, and Julian Zelizer.

  I am proud to be a founding member of a Boston area writing group that over the past six or seven years has included the likes of Steve Biehl, Jona Hansen, Jane Kamensky, Stephen Mihm, Mark Peterson, John Plotz, Seth Rockman, Jennifer Roberts, Dan Scharfstein, and Conevery Valencius. Many thanks to you all for your sharp comments, good company, and the example of your fine prose.

  Brandeis University has been my institutional home throughout this project. It is in many ways a remarkable place, and I feel blessed to have such outstanding students and engaging colleagues. In particular, I want to thank Dean Adam Jaffe and Provost Marty Krauss for their continuing support and all of my colleagues in the History Department for their warm collegiality and intellectual engagement. I have learned a good deal from Rudy Binion, Greg Freeze, Paul Jankowski, Bill Kapelle, Alice Kelikian, Govind Sreenivasan, and Ibrahim Sundiata. I especially want to thank a small group of colleagues with whom I have worked especially closely over the past decade in the American History Graduate Program: Silvia Arrom, Brian Donahue, David Engerman, David Hackett Fischer, Mark Hulliung, Jane Kamensky, and my much missed colleague, Jackie Jones. I owe a special thanks to Jane Kamensky, who has been a constant source of ideas, moral support, and excellent humor.

  I am especially grateful to a few individuals who read a draft of the manuscript late in the game and who provided thoughtful, expert comments: Art Bookstein (my father-in-law and a voracious reader of nonfiction), Jon Cohen (a close friend from our City Paper days and a first-rate science writer), David Igler (one of my oldest friends and a stellar historian), Charles E. Rosenberg (the dean of medical historians), and Conevery Valencius (who possesses an unusually deep knowledge of the medical beliefs of rural nineteenth-century Americans). D. A. Henderson, a man whom I have never met (but about whom I have read a great deal due to his leadership of the World Health Organization’s smallpox eradication program), generously read the manuscript and provided expert comments. Like most people today, I have never seen a case of smallpox, and it was both intimidating and rewarding to be able to share this project with a scientist who knows the disease and its ways so well.

  Laura Stickney at the Penguin Press has been an ideal editor for this book. As fluent as she is smart, she has edited with a sharp eye and a light hand. I am also grateful to my outstanding agent, Geri Thoma, for her unflagging support and for helping me find my way in the world of trade publishing.

  I owe everything to my family.

  Art and Lynne Bookstein have given me steady, unconditional support since I married their beautiful daughter fifteen years ago. Many thanks to Dari Pillsbury, who is a great friend and our in-house photographer extraordinaire.

  Through their steadfast love, encouragement, and the example of their own lives and work, my parents, Mason Willrich and the late Patricia Rowe Willrich, nurtured my passions for reading, writing, and teaching, and I thank them both for everything. I also wish to thank Wendy Webster Willrich for her support. I am deeply grateful to my siblings and their wonderful partners—Chris and Susan, Stephen and Kelly, and Kate and Erik—for challenging me and supporting me through the years. You’re an amazing family, and I am lucky to have you. I’ll see you soon on Stinson Beach.


  I have saved my greatest debts for last, knowing words will never be enough. Max and Emily, I am so proud of you both. Thank you for your constant reminders of the things that really matter. I love you. And Wendy Jayne Willrich, you know I couldn’t have done it without you. You know the tune: “I’m giving you a longing look....” With respect, gratitude, and the deepest love, I dedicate this book to you.

  Wellesley, Massachusetts

  Notes

  ABBREVIATIONS USED IN NOTES

  Archival Collections

  Published Government Documents

  Frequently Cited Journals

  Frequently Cited Newspapers

  PROLOGUE

  1 U.S. Census Bureau, Twelfth Census of the United States (1900), Schedule 1—Population, Manhattan, New York, New York, District 461. Note: all enumeration district-level census data cited in the notes to follow was retrieved using the U.S. Federal Census Collection in the online database Ancestry Library Edition, ancestry.com (Provo, UT). “Smallpox on West Side,” NYT, Nov. 30, 1900, 2. Robert W. DeForest and Lawrence Veiller, eds., The Tenement House Problem: Including the Report of the New York State Tenement House Commission of 1900 (New York: MacMillan, 1903), 53.

  2 “Jumped Through a Window,” NYT, Nov. 29, 1900, 4. “West Side Robberies,” NYT, Nov. 29, 1900, 5. “Chinaman Whips a Gang,” NYT, Dec. 6, 1900, 2.

  3 “Smallpox in Manhattan,” NYT, Nov. 28, 1900, 3. “Chemists Report on Water,” NYT, Nov. 29, 1900, 5. For a concise contemporary description of the pathology of smallpox, see U.S. Treasury Department, Public Health and Marine-Hospital Service, Handbook for the Ship’s Medicine Chest, by George W. Stoner, M.D., 2d ed. (Washington: Government Printing Office, 1904), 21–24.

  4 “Smallpox in Manhattan.”

  5 Ibid. On the New York City Health Department, see John Duffy, A History of Public Health in New York City, 1866–1966 (New York: Russell Sage Foundation, 1974); Evelynn Maxine Hammonds, Childhood’s Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880–1930 (Baltimore: The Johns Hopkins University Press, 1999).

  6 “Smallpox on West Side.” “Columbia Beat Indians,” NYT, Nov. 30, 1900, 8. “Thanksgiving Day Cheer,” NYT, Nov. 30, 1900, 3.

  7 D. H. Bergey, The Principles of Hygiene: A Practical Manual for Students, Physicians, and Health-Officers (Philadelphia: W. B Saunders, 1904), 374. George Henry Fox, A Practical Treatise on Smallpox (Philadelphia: J. B. Lippincott Company, 1902), 26–31. Dr. Fox was the consulting dermatologist to the New York City Health Department.

  8 “Smallpox on West Side.” “Fighting the Smallpox,” NYT, Dec. 1, 1900, 16.

  9 William Welch and Jay F. Schamberg, Acute Contagious Diseases (Philadelphia: Lea Brothers & Co., 1905), 160. For the state-of-the-art scientific knowledge about smallpox, as it existed in the United States circa 1900, see Surgeon General Walter Wyman’s “Précis Upon the Diagnosis and Treatment of Smallpox,” PHR, 14 (Jan. 6, 1899), 37–49. The authoritative modern treatise on the subject is F. Fenner et al., Smallpox and Its Eradication (Geneva: World Health Organization, 1988). See also Ian Glynn and Jenifer Glynn, The Life and Death of Smallpox (New York: Cambridge University Press, 2004); D. A. Henderson, Smallpox: The Death of a Disease (Amherst, NY: Prometheus Books, 2009), esp. 34.

  10 “Fighting the Smallpox.”

  11 On the germ theory and its reception in the United States, see Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998).

  12 “The Spread of Small-pox by Tramps,” Lancet, Feb. 13, 1904, 446–47. See also “Smallpox and Tramps,” JAMA, 22 (1894): 635.

  13 “Smallpox on West Side.” “Fighting the Smallpox.” “Smallpox up the State,” NYT, Jan. 4, 1901, 3. “New York,” PHR, 16 (Feb. 8, 1901): 238–39. See W. Michael Byrd and Linda A. Cayton, An American Health Dilemma: A Medical History of African Americans and the Problem of Race, 2 vols. (New York: Routledge, 2000, 2002).

  14 “Fighting the Smallpox.” “Race Riot on West Side,” NYT, Aug. 16, 1900, 1.

  15 “Forty Smallpox Cases,” NYT, Dec. 5, 1900, 5; “Smallpox Case in Hoboken,” NYT, Dec. 3, 1900, 5. “The Smallpox Epidemic,” NYT, Dec. 4, 1900, 8.

  16 “Fighting the Smallpox.” “Two New Smallpox Cases,” NYT, Dec. 7, 1900, 2. “Smallpox Still Spreading,” NYT, Dec. 15, 1900, 6.

  17 “Smallpox Epidemic.”

  18 “Smallpox Epidemic.” “Topics of the Times,” NYT, Dec. 12, 1900, 8. See Michael Willrich, City of Courts: Socializing Justice in Progressive Era Chicago (New York: Cambridge University Press, 2003).

  19 NOBOH 1900–01, 23. PBOH 1902, 38. Michael R. Albert et al., “The Last Smallpox Epidemic in Boston and the Vaccination Controversy, 1901–1903,” NEJM, 344 (1901), 375. NYCBOH 1901, 7–9, 56. NYCBOH 1902, 8–9. NYCBOH 1903, 8, 238. See James Nevins Hyde, “The Late Epidemic of Smallpox in the United States,” PSM, 59 (Oct. 1901): 557–67; and Charles Fletcher Scott, “The Fight Against Smallpox,” Ainslee’s Magazine, July 1902, 540–45.

  20 USSGPHMHS 1898, 598. USSGPHMHS 1901, 15. USSGPHMHS 1903, 72. USSGPHMHS 1904, 19. The Service fiscal year ran from July 1 to June 30. On underreporting, see USSGPHMHS 1899, 755–56; USSGPHMHS 1910, 189. “Echoes and News,” MN, Sept. 21, 1901, 470. “The number of cases notified each year represents at most 20% of those that actually occurred; many patients did not see a physician and many others who did were not reported as having smallpox.” Fenner et al., Smallpox and Its Eradication, 329. From my own research, I judge Fenner’s 20 percent figure to be very conservative.

  21 USSGPHMHS 1903, 72. USCB 1900, Vol. 4—Vital Statistics Part II, Statistics of Death, 228.

  22 Welch and Schamberg, Acute Contagious Diseases, 207–8. Charles V. Chapin, “Variation in Type of Infectious Disease as Shown by the History of Smallpox in the United States, 1895–1912,” Journal of Infectious Diseases, 13 (1913), 194.

  23 Pamela Sankar et al., “Public Mistrust: The Unrecognized Risk of the CDC Smallpox Vaccination Program,” American Journal of Bioethics, 3 (2003), esp. W22. Edward A. Belongia and Allison Naleway, “Smallpox Vaccine: The Good, the Bad, and the Ugly,” Clinical Medicine and Research, 1 (2003): 87–92. Vincent A. Fulginiti et al., “Smallpox Vaccination: A Review, Part II. Adverse Effects,” Clinical Infectious Diseases, 37 (2003): 251–71. Welch and Schamberg, Acute Contagious Diseases, 58–83.

  24 The literature on American antivaccinationism is growing, and it is no longer easy to dismiss the movement, as John Duffy once did, as “filled with cranks, extremists, and charlatans.” History of Public Health in New York City, 152. See, esp., James Colgrove, “‘Science in a Democracy’: The Contested Status of Vaccination in the Progressive Era and the 1920s,” Isis, 96 (2005): 167–91; idem, State of Immunity: The Politics of Vaccination in Twentieth-Century America (Berkeley: University of California Press, 2006); Nadav Davidovitch, “Negotiating Dissent: Homeopathy and Antivaccinationism at the Turn of the Twentieth Century,” in The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century North America, ed. Robert D. Johnston (New York: Routledge, 2004), 11–28; Robert D. Johnston, The Radical Middle Class: Populist Democracy and the Question of Capitalism in Progressive Era Portland, Oregon (Princeton: Princeton University Press, 2003), 177–220; idem, “Contemporary Anti-Vaccination Movements in Historical Perspective,” in Johnston, ed., Politics of Healing, 259–86. Martin Kaufman, “The American AntiVaccinationists and Their Arguments,” BHM, 50 (1976): 553–68; Judith Walzer Leavitt, The Healthiest City: Milwaukee and the Politics of Health Reform (Princeton: Princeton University Press, 1982), 76–121. On England, see Nadja Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853–1907 (Durham: Duke University Press Books, 2005). For an overview, see Arthur Allen, Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver (New York: W. W. Norton, 2007).

  25 Chapin, “Variation in Type,” 194.

  26 “The Vaccination Question and the Purity of Vaccine,” Therapeutic Gazette,
26 (1902): 98–99.

  27 For an excellent revision of the conventional periodization of free speech, see David M. Rabban, Free Speech in Its Forgotten Years (New York: Cambridge University Press, 1997). Holmes to Hand, June 24, 1918, in Gerald Gunther, “Learned Hand and the Origins of Modern First Amendment Doctrine: Some Fragments of History,” Stanford Law Review, 27 (1975), Appendix, 757.

  28 Michael Willrich, “‘The Least Vaccinated of Any Civilized Country’: Personal Liberty and Public Health in the Progressive Era,” Journal of Policy History, 20 (2008): 76–93.

  ONE: BEGINNINGS

  1 Henry F. Long, “Smallpox in Iredell County,” NCBOH 1897–98, 208.

  2 U.S. Census Bureau, Twelfth Census of the United States (1900): Schedule No. 1—Population, Iredell County, North Carolina. “Dr. John F. Long Dead,” CO, Apr. 29, 1899, 4. Federal Writers’ Project, North Carolina: A Guide to the Old North State (Chapel Hill: University of North Carolina Press, 1939), 71–78, 401–7. Hugh Talmage Lefler and Albert Ray Newsome, North Carolina: The History of a Southern State (Chapel Hill: University of North Carolina Press, 1954), 481–83.