Pox
Page 2
Once two dozen cases of smallpox had turned up on the West Side, the question of the outbreak’s precise origin became almost moot. Whoever had started it—the minstrel man of All Nations Block, the unnamed “negress,” Albert Sanders, or someone else—the outbreak would now be difficult to contain.
By December 6, one week after Thanksgiving, the New York papers were calling the outbreak a full-blown smallpox epidemic, the worst in Manhattan since 1892. Three of the patients on North Brother Island had already succumbed to the disease: the servant Mary Holmes; twenty-year-old Elizabeth Oliver; and the Crowley infant, whose mother, it seemed, had not had the heart to name her. The pesthouse now held forty-four smallpox patients, with more arriving almost every day. All hopes of keeping the outbreak quarantined in a small area of the city had vanished when five-year-old Sadie Hemple, until recently a resident of West Sixty-ninth Street and pupil at the Riverside Kindergarten, turned up across the river in Hoboken with a case of smallpox. The virus had incubated in her body while she and her parents moved to their new home, a five-story tenement house where some twenty other children lived. The Hoboken authorities removed Sadie to their own pesthouse, in a place called Snake Hill. New York officials had to concede that the West Side outbreak had “overleaped the bounds” of All Nations Block.15
The health department’s vaccination corps was now scraping the arms of the poor at the rate of fifteen hundred per day. Resistance to vaccination had abated in some of the infected areas—where the people were, in the words of one city vaccinator, “well scared up.” More than five hundred poor people called each day for free vaccinations at the board of health’s headquarters on West Fifty-sixth Street, most of them mothers with little children in tow. But with each new outbreak in another of the island’s crowded tenement districts, the vaccination corps met fresh resistance. Over time, the corps would ever more closely resemble a military outfit. Across the city, private physicians and druggists bought up “hitherto unheard of quantities” of the health department’s vaccine stock. At factories, department stores, and offices, employers told their employees to get vaccinated or not bother showing up. On Wall Street, the managers of the New York Stock Exchange set up their own on-site vaccination station. All employees had to submit to the procedure before they could take their positions in the great scrum of the trading floor.16
Among the many political effects of the widening epidemic in New York City was an earnest moral discourse, as the city’s chattering classes mulled the significance of the event. The ancient and filthy scourge of smallpox had struck at the very heart—and, it seemed to many, the very moment—of modern American civilization.
The New York Times, the moderately progressive voice of elite opinion, published a series of editorials in which it called the epidemic “a matter of grave public concern.” The editors cautioned their affluent readers against indifference; the outbreak was no longer safely confined to “the congested tenements of one locality.” “Public conveyances and places of public assembly bring all classes together to such an extent that only the recluse can feel quite safe,” the Times advised, “and not even the recluse if ministered to by servants who visit friends in the infected districts.”17
Such a recognition of the inescapable interdependence of modern urban life stood as the grand unifying theme of the many disparate progressive reform campaigns of the turn of the century: movements for safer working conditions, social insurance for wage earners and their families, better housing for the poor, new programs to rehabilitate criminals, and innumerable measures to protect the public health. The same ethical and political logic, which held individual liberty subordinate to the collective interests of society, underlay the Times’s call for universal vaccination: “This is not only a wise measure of personal precaution, but it is a public duty which every citizen owes to those with whom he comes in daily contact.” The Times was prepared to take this logic to its furthest conclusion and endorse the most punitive measures for vaccination in the “great and crowded city.” But the editors expected that such measures would prove unnecessary. The “anti-vaccination heresies” that had spread so perniciously in England and other foreign countries in recent years would find few followers in the United States, the Times insisted. “Here a saving common sense has prevailed in all classes of the population, and smallpox works serious ravages only in remote corners inhabited by out-and-out savages.” A progressive appeal to social interdependence, civic obligation, and enlightened common sense did not, in this instance, imply tolerance, empathy, or solidarity. Or good taste: three people had recently died in the city, ravaged by smallpox. Were they “savages”? 18
These were, of course, the overheated ruminations of editorial writers. The Times’s editors got the high moral tone of the moment just right, and the facts of the historical events unfolding around them all wrong.
In December 1900, the United States was in the throes of an extraordinary five-year wave of smallpox epidemics. It was the worst visitation of smallpox in a generation or more, and the last Americans would experience on a continental scale, as a national event. From Alabama to Alaska, no state or territory was untouched. Smallpox made its way across an increasingly interconnected American landscape: from southern tobacco plantations to western mining camps to immigrant tenement districts in aging east coast cities; from the nation’s capital in Washington to Filipino and Puerto Rican villages on the farthest edges of the new American empire. The epidemics did not confine themselves to a few “remote corners” of the country. Many major American cities experienced deadly epidemics. New Orleans reported nearly 1,500 cases and 450 deaths in 1900. In Philadelphia, smallpox infected 2,500 people and killed nearly 400. Boston recorded 1,600 cases and 270 deaths. And by the time the smallpox epidemic that started on All Nations Block was through with New York City in 1902, the health department had recorded 2,100 cases, and 730 men, women, and children lay dead.19
No reliable figures exist to quantify the overall damage done by small-pox to American lives, commerce, and property during these epidemic years. The U.S. Public Health and Marine-Hospital Service, the federal disease-control agency, conceded that its smallpox statistics were woefully incomplete. The federal officials dutifully published the data they received from state and local health boards, but in many states those agencies were just coming into their own. Many smallpox-infected communities lacked the will or the wherewithal to accurately report cases of infectious disease.
Still, the admittedly spotty statistics of the federal health service suggest the broad chronological arc of the epidemics. At the beginning of 1898, smallpox was largely absent in the United States, apart from a few trouble spots, mostly in the South, including Birmingham, Alabama, and a hard-bitten Appalachian coal town called Middlesboro, Kentucky. As Surgeon General Walter Wyman of the Public Health and Marine-Hospital Service recalled, “[I]t was during the winter of 1898–99 that the disease began to assume great proportions.” In 1899, the service reported more than 12,000 cases, from all over the South, followed by 15,000 cases, now in the mid-western states, too, in 1900. In 1901, the number of new cases surged to nearly 39,000. According to the Medical News, by then the distribution of smallpox in the United States had become “alarmingly general.” In 1902—the year Wyman would remember as “the high-water mark” of the epidemics—the service counted 59,000 new cases. The agency tallied another 42,590 new cases in 1903. By the end of that year, the surgeon general assured the nation that “the disease has spent its force and will now continue to decrease until it practically disappears.” In fact, smallpox did taper off dramatically in 1904, but the disease did not disappear. Smallpox would continue to trouble American communities until the last reported U.S. case occurred in 1949. All told, during the five-year wave of epidemics around the turn of the century, the federal service counted 164,283 American cases of smallpox. The actual number of cases may have exceeded five times that figure.20
But for American public health officials, the tr
uly stunning statistic from those epidemics was the body count. It was shockingly low. According to the federal health service reports, only 5,627 people died. Again, the mortality figure was impressionistic at best; the Census Bureau independently reported nearly 4,000 smallpox fatalities in 1900 alone (more than five times the health service’s figure for that year). Still, all agreed that the death toll was astonishingly, inexplicably, blessedly small. If smallpox had measured up to its historical virulence, the epidemics of 1898–1903 would have killed at least 50,000 Americans .21
Although in some places smallpox proved as destructive as ever, in the vast majority of American epidemics after 1898, the disease seemed to have lost its lethal force. Vaccinal protection could not explain the phenomenon: when the smallpox came, most Americans had not been vaccinated in years. It seemed a new “mild type” of smallpox had appeared on the epidemiological landscape, the likes of which the “civilized” nations of Europe, England, and the United States had never seen. No one could say how long the new pox would remain mild. Many medical authorities expected the disease to revert to classic, malignant smallpox at any moment. For American health officials, the low mortality rate posed the greatest medical mystery—and the toughest political challenge—of the turn-of-the-century smallpox epidemics.22
The sudden appearance of a new mild form of smallpox altered the political calculus of compulsory vaccination—a measure that had been none too popular in late nineteenth-century America. To this day, medical experts consider smallpox vaccine, which contains a bovine virus called vaccinia, “the least safe vaccine available.” Serious complications, including postvaccinial encephalitis and death, are rare: scientists expect one million vaccinations to cause three to five serious reactions. But milder reactions—rashes, fatigue, headache, fever, painfully tender arms—are common. In 1900, vaccination carried significantly greater dangers. The government compelled vaccination, but did little to ensure that American vaccine makers produced safe, effective vaccine. Newspaper stories, medical texts, and popular rumors linked vaccination to syphilis, tetanus, and the ubiquitous “sore arms” that caused countless American breadwinners to lose days or even weeks of work. Because the new pox killed less than 1 percent of the people whom it infected, many laypeople and even doctors refused to believe it was smallpox at all. In the absence of a recognizably horrific case of smallpox, many failed to see the benefit of vaccination. Many saw vaccination as the greater risk to life and limb. And their resistance to compulsory vaccination would help persuade the federal government to impose new regulatory controls on the American vaccine industry.23
But reasonable health concerns do not alone explain the widespread opposition to compulsory vaccination at the turn of the twentieth century. Antivaccinationism was an international phenomenon, but everywhere it reflected the social divisions and political tensions of its time and place. The roots of American antivaccination sentiment ran deep and wide. Race stymied smallpox control, as white taxpayers, particularly in the South, balked at paying for vaccine to protect blacks; meanwhile, African Americans rightly mistrusted government vaccinators whose chief aim was to protect the white community. Christian Scientists viewed compulsory vaccination as a violation of religious freedom. Physicians who practiced popular forms of alternative medicine decried government vaccination orders as yet another example of creeping “state medicine.” Parents resented school vaccination mandates for encroaching on their domestic authority and for violating their children’s innocent bodies. Antivaccination propagandists traced compulsory vaccination to a corrupt conspiracy between health officials, lawmakers, and vaccine manufacturers. On the broadest level, though, the vaccination question revealed a sharp uneasiness toward the authority of medicine and the power of the state at the height of the Progressive Era, a period of time when both institutions were reaching more ambitiously than ever before into American life.24
Contrary to the Times’s assertion, then, an unquestioning submission to vaccination was anything but the “common sense” of the American people during these smallpox outbreaks—even in the many places where local and state governments made such submission compulsory by law. Ordinary Americans responded to government vaccination orders in a variety of ways, ranging from ready compliance to violent riots. They organized antivaccination societies, conducted legislative campaigns (some of them successful) to repeal state vaccination laws, and flooded the courts with lawsuits challenging compulsory vaccination as a violation of their constitutional rights. More often, people resisted public health authority in more private, mundane ways: by concealing sick family members at home, forging vaccination certificates, or simply dodging their legal duty to be vaccinated. In the aftermath of this nationwide fight against smallpox, the United States would remain, in the words of one of the nation’s preeminent public health experts, “the least vaccinated of any civilized country.”25
The aim of this book is to explain why this was so. To trace the origins and broader significance of smallpox and the “vaccination question” in Progressive Era America, I have found it necessary to stray far from the familiar narrative conventions of the epidemic tale. This is not a story of rising body counts and medical heroics—though the changing lethal power of the smallpox virus, the emergence of the modern vaccine industry, and the strenuous work of public health officials are all central to this narrative. Nor is the story told in these pages a comforting tale of human solidarity springing up in unexpected places: the tragic disaster that forces the people of a community to overcome their differences and work together to survive and rebuild. The smallpox outbreaks of the turn of the century did occasion such moments, and they are remembered here. But the history of these American epidemics is, inescapably, a history of violence, social conflict, and political contention. And that made all the difference .26
America’s turn-of-the-century war against smallpox sparked one of the most important civil liberties struggles of the twentieth century. To readers versed in the scholarly literature about American civil liberties, this claim may sound curious (or even spurious). According to the conventional text-book narrative, the modern era of civil liberties properly begins with the famous free speech cases of the post–World War I era, when the U.S. Supreme Court established new First Amendment protections for political dissent. But contemporaries of the period, including no less a giant of the American legal realm than Justice Oliver Wendell Holmes, Jr., of the United States Supreme Court, recognized that the celebrated free speech battles reprised constitutional questions that the vaccination struggle had raised for Americans two decades earlier. As Justice Holmes wrote in a 1918 letter to Judge Learned Hand, “Free speech stands no differently than freedom from vaccination.”27
In a burst of litigation arising from the smallpox epidemics, the critics of compulsion had carried the vaccination question all the way to the U.S. Supreme Court in 1905. They raised a broad set of questions about the nature of institutional power and the bounds of personal liberty in a modern urban-industrial nation. Their demands went far beyond the right to speak out against the government. The critics of compulsory vaccination insisted that the liberty protected by the Constitution also encompassed the right of a free people to take care of their own bodies and children according to their own medical beliefs and consciences. It was a bold but deeply problematic claim. And it brought the opponents of compulsory vaccination into direct conflict with the agents of an emerging interventionist state, whose progressive purpose was to use the best scientific knowledge available to regulate the economy and the population in the interests of the social welfare.28
This, then, is the story of a largely forgotten American smallpox epidemic that killed relatively few people but left a surprisingly deep impression on society, government, and the law. The story begins where the epidemics did, in the fields and work camps of the New South.
ONE
BEGINNINGS
“To begin at the beginning, and I think it was the beginning,” Dr. Henry F
. Long wrote in his 1898 report to the North Carolina Board of Health, “the first smallpox experience we, of Iredell, had, was when the negro Perkins made his way from Neal’s camp, on the M & M Railroad, to Charlotte.”1
Henry Long was the superintendent of health of Iredell County, an area of low ridges and valleys known for its loamy soil and its many creeks. Most of the citizens were North Carolina natives, like their mothers and fathers before them. Long himself carried on the medical practice established by his father in Statesville, an old town of wide, elm-lined streets that served as the county seat. In the past twenty years, the hum of industry had altered the rhythm of life in the Piedmont. Farming families and respectable townspeople like the Longs had had to accustom themselves to growing numbers of wage earners and outsiders. Apart from farming wheat, the people now spent their days making furniture, processing tobacco, tending textile machines, working on the railroads, and, as ever, raising families. Until the winter of 1898, most folks in Iredell County had never seen a case of smallpox. Then that, too, changed.2