Pox (40 page)

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

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

 

 

O
n 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