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By Root 508 0

an important fact about the contentious history of civil liberties in modern America: free speech wasn’t the half of it. Beginning with the vaccination struggles of the turn of the century, in an era of fast-growing institutional power, ordinary Americans again and again challenged the courts to create new protections for personal liberties—including rights to individual autonomy, medical privacy, and bodily integrity. Harlan’s opinion had treated those claims with a measure of respect. At the very least, he recognized that they were worth fighting for. He said, “There is, of course, a sphere within which the individual may assert the supremacy of his own will and rightfully dispute the authority of any human government, especially of any free government existing under a written constitution, to interfere with the exercise of that will.”125

But Harlan recognized that under the necessitous conditions of modern life, human freedom sometimes meant little without purposeful governmental action. And so, in Jacobson v. Massachusetts, the U.S. Supreme Court gave its blessing to an unpopular but effective public health technology that would one day be used to eradicate the most deadly disease the world has ever known.

EPILOGUE

Gone are the days of the pesthouse and the detention camp—the tent city thrown up at the edge of town, its gas-fired torches standing sentry through the night. Gone, too, the days when we looked into the pockmarked face of a stranger on a crowded streetcar, or a loved one across the table. We have lost the habit of rolling up our sleeves to display our vaccination scars to the medical inspector at the border, the nurse at the schoolhouse door, or the conductor on the departing train. With each passing year, more of us have no scar to show. All of these things are gone, because smallpox is gone.

America’s turn-of-the-century war on smallpox did not kill humankind’s ancient foe. But it did mark the beginning of the end for the disease in the United States. The deadly New York smallpox epidemic that started in All Nations Block on Thanksgiving Day 1900, setting Alonzo Blauvelt’s vaccination corps into motion in the tenements and factories, was to be the city’s last. Boston, too, had seen its final smallpox epidemic during the deadly 1901–3 visitation that sealed the city’s reputation as a “hotbed of the anti-vaccine heresy.” Over the next twenty-nine years, the city reported a hundred-odd cases, just four of them fatal, and then the pox vanished for good. The story was much the same in Philadelphia, Cleveland, Seattle, and other places where smallpox had raged during the first years of the century.1

By World War I, a rough pattern had taken hold. Outbreaks of malignant variola major became rare events, aggressively stamped out by America’s increasingly well-organized health departments through a combination of mass vaccination and swift isolation of patients. Having learned something on the vaccination battlegrounds of the turn of the century, public health professionals self-consciously eschewed compulsion and force for public education and the promotion of the idea that every citizen had a positive right to good health. As C.-E. A. Winslow of the Yale School of Medicine observed, “Public health conceived in these terms will be something vastly different from the exercise of the purely police power which has been its principal manifestation in the past.” Of course, every profession seeks to elevate itself by disclaiming the backwardness of its predecessors. And the new public health, far from a retreat, implied a much more ambitious program for governing everyday life in America. But over time, ordinary Americans did more fully accommodate themselves to the call for mass vaccination when the deadlier form of smallpox invaded their communities. When variola major reappeared in Detroit in 1924, causing 163 deaths, a half-million residents submitted to vaccination in a single month.2

But the new mild type of the disease remained far more difficult to control. Variola minor became the dominant form of