In an era when American governments took ever greater responsibility for children—through child labor laws, school laws, and new child-welfare institutions such as the juvenile court—the vaccination rules served multiple purposes. As some health officers pointed out, it would have been unconscionable for states to require children to spend half their day in crowded classrooms without protecting them against socially transmitted diseases. The measures, coupled with increasingly routine medical inspections in the public schools, also extended state authority from the school into the home, bringing working-class and immigrant parents into line with new progressive norms of hygiene. When unvaccinated children were excluded from school, their parents could face prosecution under education laws. Some officials even imagined that the requirement made a positive impression on the students—“familiarizing the juvenile mind with respect for authority,” as one put it, “whatever the merits of the medical expedient may be.”44
Compulsory vaccination turned American public schools into theaters of conflict. Parents, pupils, teachers, and sometimes even principals challenged the rules with tactics ranging from civil suits to civil disobedience. Parents decried the measures as a violation of their domestic authority and a threat to their children’s health. Officials in Chicago and New York uncovered what the Times called “an extensive traffic” in phony vaccination certificates. The school strikes that rocked Camden and Rochester after Camden’s tetanus outbreak were not isolated incidents. In Gas City, Indiana, two hundred mothers, holding their unvaccinated children by the hand, marched upon the public schools building on a December morning in 1902. Facing down a contingent of policemen at the schoolhouse doors, they demanded that their “scarless” children be admitted.45
In nearby Bluffton, Indiana, the school board squared off against the health board, refusing to enforce the latter’s vaccination order. In Delaware County, Pennsylvania, a group of female teachers refused to let physicians examine their arms for scars, protesting a policy that compelled them to undergo a risky medical procedure before entering their workplaces. Students caused trouble, too. Visiting Newburg, Ohio, Cleveland health officer Martin Friedrich came upon some children outside their school. The students called out to each other, “Are you vaccinated? Are you vaccinated?” Friedrich understood: the vaccinators were in the schoolhouse. He slowed his pace and listened. “Pretty soon I knew what they were up to,” he recalled. The corner grocery-man had told some of them that they should wash the vaccine from their arms to keep them from getting sore. “They communicated it to each other in a most lively manner, and all hurried as fast as they could to the grocery-store to wash their arms.”46
New York City schoolboys line up to have their vaccination marks inspected by a public health officer in 1913. COURTESY OF THE NATIONAL LIBRARY OF MEDICINE
Mass vaccinations at American workplaces generated their own dynamics of power and conflict. American workers were vulnerable not only to contagion but to arbitrary dismissal during epidemics. Domestic employers, fearing exposure to infection, shunned servants and laundresses, causing destitution in the tenements. When smallpox broke out, some factory owners abruptly suspended operations, with no thought of compensating their workers for lost wages. In a typical incident in Sayreville, New Jersey, two handkerchief manufacturers, acting upon the advice of physicians, told their employees to stay home until the local epidemic was brought under control. The order affected about three hundred workers, many of them the breadwinners of their families. Workers pleaded with foremen. One factory girl dropped to her knees and prayed. All to no avail. To employers and local health officials, the mere threat of smallpox justified the most overt acts of ethnic scapegoating. When a single Italian worker with smallpox escaped from quarantine in Bethlehem, Pennsylvania, in 1902, Bethlehem Steel Company summarily discharged all of its Italian workers. Italians were forbidden to ride the city streetcars until the outbreak subsided .47
Employers normally bristled at workplace health regulations. Key pieces of progressive labor legislation—including factory safety measures and laws to shorten the workday—were justified by reformers as necessary to protect the health of workers and the public. Manufacturers’ associations and individual employers challenged such measures in the courts, insisting they violated the “liberty of contract” between worker and employer. But when faced with the potentially expensive emergency of a smallpox epidemic that had a relatively cheap solution (vaccination), many industrial employers readily cooperated with public health officials. They willingly turned their private workplaces into public health stations.48
Many employers made vaccine refusal grounds for dismissal. In one 1901 episode, six Brooklyn health department physicians, policemen in tow, appeared at the sugar refineries of Havemeyer & Elder, just in time for payday. As each worker stepped forward to receive his wages, a city doctor vaccinated him. Railroad and streetcar corporations, liable for damages if an employee with smallpox infected a passenger, were particularly vigilant. In the winter of 1903, as smallpox raged in the Pennsylvania coal region, officials of the H. C. Frick Coke Company, a vast industrial enterprise of coal mines and coke works, ordered all of its employees and their families to get vaccinated. According to the Chicago Tribune, the order affected 300,000 men, women, and children.49
When employers joined forces with local health officers and police to enforce vaccination, a crowded factory floor could become as confining as a prison. In April 1901, a female worker at the American Tobacco Company in Passaic, New Jersey, died of smallpox. She had continued to work during the early contagious stages of her disease. In such an instance, any responsible employer would want to secure the safety of his workplace by assuring that the workers got vaccinated. But the measures taken at the American Tobacco Company went well beyond that duty. A squad of government physicians and police entered the plant, determined to vaccinate all 350 women and girls who worked there. Informed they would have to submit to vaccination, some workers fainted, “others became hysterical, and there was a general rebellion,” The New York Times reported. Two hundred of the women tried to escape, but they found all of the factory exits locked. “[A]ll were finally vaccinated.”50
As C. P. Wertenbaker observed time and again in the South, workers’ natural fears of vaccination were intensified by their need to earn. Many American industrial workers feared, with good reason, that vaccine would cause their arms to swell, making it impossible for them to support themselves or their families for a period of days or weeks. And they knew better than to expect their bosses or the state to support them during that period of disability. Some washed off vaccine (as Martin Friedrich spied workmen doing at an Ohio factory). Others walked off job sites rather than be vaccinated. African American workers, in particular, dreaded vaccination. In June 1900, the New York State Board of Health ordered the vaccination of five hundred black workers at the Wash & Company brickyard in Stockport, New York, about thirty miles down the Hudson from Albany. According to The New York Times, when fifty of the laborers “refused to submit,” Governor Theodore Roosevelt sent in the Hudson Company of the state militia, “ninety men strong,” to enforce vaccination against the “unruly negroes.”51
Violence was always a possibility when health officials clashed with American workers. In 1902, smallpox struck the neighboring mining cities of Lead and Deadwood, in the Black Hills of South Dakota. Both cities ordered a general vaccination, but the miners balked. The city physician of Lead—accompanied by four assistants, the sheriff, and five deputies—conducted a nighttime raid of the city’s crowded saloons, gambling dens, and theaters. At the Gold Mine Saloon, the officers covered both entrances and proceeded to vaccinate everyone in the place. Several fights broke out, but eventually the police overwhelmed the miners.52
Controlling smallpox on the nation’s vast network of railroads was obviously a crucial step to stamping out the American epidemics. But how? In the winter of 1902, Chicago health officials announced a Chicago-sized plan. The
Second City stood at the hub of the nation’s transportation networks. The same central geographical position that made Chicago such an economic force—bringing grain, lumber, and livestock from the rural hinterland to American markets and sending Montgomery Ward catalogues back in the other direction—made the city vulnerable to smallpox outbreaks all over the Middle West. In January 1902, about 10,000 cases of smallpox—roughly three fourths of all reported cases in the United States—occurred within a few hours’ train ride from Chicago. The Chicago Health Department decided to use the Second City’s position as the railroad hub of the Middle West to stamp out smallpox in a ten-state region with 25 million inhabitants. City health officials made an agreement with officials of the major companies serving Chicago to spur “wholesale vaccination and revaccination in every infected locality” of the region by enforcing a strict inspection of all travelers from those communities. The railroads also ordered all of their employees serving the Chicago routes to submit to vaccination or lose their jobs. And every car entering the city from any direction had to be fumigated for six hours before new passengers were allowed to enter it.53
Across the American political landscape, public ambivalence about compulsory vaccination during the turn-of-the-century epidemics registered in the statute books. Mississippi, one of the states hardest hit by virulent smallpox in 1900 and 1901, enacted a new law authorizing county boards to order compulsory vaccination (which many refused to do). Rhode Island passed a new law in 1902 that mandated vaccination of all children before their second birthday and empowered the state board of health to order vaccination of all “inmates of hotels, manufacturing establishments, hospitals, asylums, and correctional institutions.” That same year, Massachusetts gave local health boards authority to compel vaccination at will.54
Other states, though, moved the other way. Wisconsin governor Robert M. La Follette vetoed a new compulsion statute in 1901, insisting (as the Journal of the American Medical Association remarked with disbelief) that “he does not believe an emergency exists which demands a law repugnant to so many good citizens!” In Utah that same year, grassroots opposition to compulsory public school vaccination spurred the legislature to pass a law banning compulsion. The Wasatch Wave applauded the statute: “it robs the tyrant of his power to rob the people of their right to ‘life, liberty and the pursuit of happiness.’ ” And two years later, well-organized antivaccination activists in Minnesota persuaded the legislature to forbid compulsion in the absence of an actual smallpox emergency.55
New York lawmakers debated a compulsory vaccination bill in 1902. The state had long banned unvaccinated children from the public schools. But beyond that the legislature had not ventured, prompting The New York Times to assert, “compulsory vaccination is a thing utterly unknown in this State.” In February 1902, State Senator James McCabe, a physician from Brooklyn, introduced a bill that would have been one of America’s strongest vaccination laws. It required cities to enforce universal vaccination whenever the health department called for it. Any resident who refused vaccination was subject to a $50 fine and imprisonment for ten days. Companies with more than ten employees were forbidden to hire anyone not vaccinated within the past five years. The New York County Medical Association championed the measure. So did the Times. Remarkably, the New York City Board of Health opposed the bill. The city’s new health commissioner, Dr. Ernst J. Lederle, explained that the legislation would simply hand the city’s antivaccination leagues a tool for recruitment. Compulsion was unnecessary, Lederle insisted. His department had encountered “no serious difficulty . . . in persuading the people to submit to vaccination.” The bill died in the New York Assembly.56
Residents of New York City—at least those who lived in the tenements or read the daily papers—must have found Ernst Lederle’s public position on compulsion baffling. A Ph.D.-bearing chemist, Lederle had taken office in January 1902, appointed by the city’s new reform mayor Seth Low to head up both the board of health (which promulgated health regulations for the city) and the department (which carried them out). High on the list of disgraceful conditions that Low’s administration promised to eradicate was smallpox, which had continued to spread despite the aggressive tactics of Alonzo Blauvelt’s vaccination corps. Nearly 2,000 cases, with 410 deaths, had been reported in the city’s five boroughs in 1901, making this New York’s worst smallpox epidemic since 1881.57
For Lederle, smallpox was the most interesting problem confronting a modern department whose activities covered everything from making vaccine to policing milk dealers to arresting the spitters who spread the city’s deadliest endemic disease, tuberculosis. Smallpox concentrated Lederle’s mind on the larger purpose of his office: to extend the benefits of modern medicine to the city’s “great tenement population—ill-housed, illnourished, bred in the foul air of the slums; above all, ignorant of the laws of cleanliness and right living, and willing to go to any lengths to hide the evidence of disease from the municipal physicians.” Tellingly, Lederle expressed admiration for the work of the U.S. Army Medical Department in Havana, “a striking example of what can be done in a short time.”58
Under Lederle, the health department managed compulsion well enough without a law that would have strengthened the political base of antivaccinationists and given Albany a greater hand in the affairs of local health departments. Lederle publicly denied that coercive legal power was necessary, even as his department routinely exercised just such power in the city’s tight spaces. Lederle added more than 150 new men to the vaccination corps. By the end of his first year in office the department performed a record-breaking 810,000 vaccinations—more than twice as many as in any previous year. The commissioner sent letters to the owners of all the city’s larger factories, offering them the services of a vaccination squad, at any hour of the day or night. His board of health ordered lodging houses to refuse shelter for more than one night to anyone who failed to provide proof of recent vaccination. Discovery of a pimple-faced passenger aboard a trolley in the Bronx in March 1902 was sufficient cause to reroute the train, with all the passengers aboard, to the nearest police station, where a city health officer got busy with lancet and virus. “Those who objected were sternly admonished and the work went on.” The following month, James Butler, a hostler, and his wife, Kate, living on the third floor of a Third Avenue tenement in Harlem, were discovered “suffering from smallpox in an advanced stage.” A vaccination squad arrived, backed by twenty police officers. Men, women, and children fled down fire escapes or climbed to the roof. “But policemen were at hand at every place of egress, and appeals and entreaties were unheeded,” the Times reported. By the raid’s end, 300 residents had been vaccinated, “the majority of them very much against their will.” James Butler was found hiding in a coal bin. After a struggle, he and Kate were taken to North Brother Island.59
In November 1902, a health department inspector discovered a person with smallpox in a tenement on West Twenty-sixth Street inhabited by forty African Americans. The inspector summoned the police. They stormed the door. As the Times reported, “When the attacking party entered, some of the inmates went to the roof, some climbed out to the fire escape, and others tried to gain the street.” City physicians took out their instruments and began vaccinating the residents. Four were vaccinated in the hallway, others “in the corners of rooms where they had huddled together for refuge.” Still others received their “treatment” on the roof. One of the lodgers, twenty-four-year-old Eva Gerry, climbed out onto the fire escape, lost her balance, and fell three stories to the sidewalk, breaking both of her arms and several ribs.60
The department under Lederle did not do away with compulsion. It expanded the scope and intensity of the same old tactics. In fact, Blauvelt continued to head up the Division of Contagious Diseases. The department’s measures undoubtedly did much to bring the New York City small-pox epidemic of 1901–2 to an end. In 1902, the Division of Contagious Diseases reported 1,516 more cases with 309 more fatalities. Most of
them occurred in the first six months of the year, after which the epidemic tapered off. In 1903, only 67 cases were reported, with just 4 fatalities; 40 percent of the people with smallpox treated in the municipal hospitals were new arrivals to the city. The department performed an additional 215,000 vaccinations that year, bringing the grand total under Lederle’s two-year regime to well over a million, roughly one third of the city’s population.61
As Scientific American noted, in a laudatory article on Lederle’s department, the city’s “crusade against smallpox” had engendered “bitter opposition.” It was strongly “opposed by the ignorant and superstitious, and by a considerable body of the more intelligent who were opposed to vaccination on principle. The inspectors were openly abused and resisted, and it was only through the co-operation of the police that an effective campaign was conducted.”62
In November 1903, Mayor Seth Low ran for reelection on a campaign that trumpeted his administration’s victorious war on smallpox. Campaign posters placed on elevated trains displayed the words of the reformer Jacob Riis, who urged New Yorkers to vote for the man who had driven prostitution from the tenements and “wiped out the smallpox in six months.” The voters, though, were not sufficiently impressed. They returned control of City Hall and the health department to the Democrats. Ernst Lederle left the department and founded the profitable Lederle Antitoxin Laboratories, manufacturers of vaccine, sera, and other biological products.63
New York was not the only American city to deploy paramilitary vaccination squads. The Chicago Health Department sent teams of physicians and police on nighttime raids to the tenements and into the cheap lodging houses along South Clark Street. In Boston, a notorious “hotbed of antivaccinationism,” nineteen citizens were prosecuted for refusing to submit to vaccination as city physicians and police made door-to-door sweeps. One night in November 1901, the health department sent a “virus squad” to the “five and ten cent” lodging houses in the South End. Physicians carrying lancets were accompanied by club-wielding police. The squad busted down doors. Policemen held down struggling men on their cots while doctors performed the operation. According to a Boston Globe reporter, the “tramps” fought back. They “kicked and clawed and also fought with teeth and heads against what some of them declared was an assault upon their rights as otherwise free and independent American citizens.” The homeless men uttered “every imaginable threat from civil suits to cold-blooded murder.”64
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