Pox_ An American History - Michael Willrich [131]
That writer was wrong. As health officials and police tightened enforcement of vaccination at public schools, industrial work sites, and railroad depots, Americans started forging scars. Some tried plaster fakes. Others followed recipes printed in unorthodox medical journals and passed along by word of mouth. “Get a little strong nitric acid,” advised the Columbus, Ohio–based journal Medical Talk for the Home. “Take a match or a toothpick, dip it into the acid, so that a drop of the acid clings to the end of the match. Carefully transfer the drop to the spot on the arm where you wish the sore to appear. Let the drop stand a few minutes on the flesh. Watch it closely.” After a few minutes, the skin, stinging, turned red. That meant it was time to blot up the remaining acid. In a week, the nickel-sized spot turned dark. “This sore will gradually heal by producing a scar so nearly resembling vaccination that the average physician cannot tell the difference.” Health officials condemned the “vile crime” as the handiwork of a few antivaccination fanatics. But these intimate acts of civil disobedience were part of something larger, a groundswell of popular opposition to “state medicine.”40
“True compulsory vaccination,” as Health Officer Charles V. Chapin of Providence defined it, aimed to secure general immunity from smallpox by requiring every member of the community to be vaccinated and periodically revaccinated. The model was Germany, which boasted the world’s most vaccinated population and the one most free from smallpox. German law required that every child be vaccinated in the first year of life, again during school, and yet again (for the men) upon entering military service. The U.S. Constitution, as interpreted at the time, foreclosed any serious talk of achieving such a universal system through federal law. That left the matter to the states. Hard political realities—the diversity of state legal cultures, the uneven development of their public health systems, and the suspicion with which many Americans greeted any government interference with their personal liberties—assured that a German-style system of vaccination, covering the entire U.S. population, never came to pass. Most vaccination laws on the books were the residue of bygone epidemics. As the emergencies that begot those laws faded from memory, enforcement waned.41
For all of these reasons, the epidemics of 1898–1903 found many communities poorly protected by vaccination. New circumstances made health officials’ jobs even harder. The advent of a milder type of smallpox and heightened concerns about vaccine safety hindered the efforts of public health officials, who often received little support from lawmakers, government executives, and the public.
Still, when confronted with a costly smallpox epidemic, the same governments that during times of relative health shied away from compulsory measures readily resorted to coercion. The emergency powers they exercised were extraordinary—particularly in thickly populated spaces. In his definitive 1904 treatise The Police Power, Professor Ernst Freund of the University of Chicago Law School covered every form of state regulatory action from liquor licensing to the suppression of labor strikes to trust-busting. But he singled out compulsory vaccination to illustrate the outer limits of legitimate state action. “Measures directly affecting the person in his bodily liberty or integrity,” he wrote, “represent the most incisive exercise of the police power.” During the turn-of-the-century epidemics, millions of ordinary Americans could not enter their work sites, send their children to public school, or travel freely without showing their vaccination scars. To them, the metaphor of the passport seemed real enough.42
Besides soldiers, prisoners, and immigrants fresh off the boat, the most vaccinated members of American society were public schoolchildren. School vaccination rules paved the way for a growing