Pox_ An American History - Michael Willrich [22]
Sol Ettinge, “Vaccinating the Poor.” The engraving pictures a New York City police station house during the 1872 smallpox epidemic. From Harper’s Weekly, March 16, 1872. COURTESY ROBERT D. FARBER UNIVERSITY ARCHIVES AND SPECIAL COLLECTIONS DEPARTMENT, BRANDEIS UNIVERSITY
For Surgeon General Wyman, the case for compulsion was simple: it worked. He reminded Americans of the lesson of the Franco-Prussian War of 1870–71. As the French and Prussian armies collided, the war unleashed a pandemic of smallpox that killed more than half a million people in Europe, including some 143,000 German civilians. Both France and Prussia had poorly vaccinated civilian populations. But the armies differed dramatically. The thoroughly vaccinated Prussian army, 800,000 men strong, suffered only 8,463 cases of smallpox and just 457 deaths (a case-fatality rate of 5.4 percent). The smaller, sparsely vaccinated French army counted 125,000 cases and 23,375 deaths (18.7 percent). After the war, many European countries enacted new legislation compelling vaccination (and in some places subsequent revaccination) as a basic duty of citizenship.58
As epidemics broke out in the United States during the next few years, American state and local governments responded with measures of their own. Again, the German example proved irresistible. By an 1874 law, the unified German state required all citizens to submit to vaccination and revaccination. In 1899 the disease took only 116 lives in Germany, a nation of 50 million people. For Wyman, the success of vaccination imposed a clear moral responsibility upon American citizens and their governments. “Smallpox is a disease so easily prevented by vaccination that the smallpox patient of to-day is scarcely deserving of sympathy,” he wrote in December 1899, as the wave of epidemics that had begun in the South moved across the country.59
But vaccination carried its own well-known health risks, and compulsory measures clashed with medical beliefs, religious tenets, the rights of parents, and dearly held notions of personal liberty. As nations tightened their smallpox vaccination laws in the late nineteenth century, those efforts ran up against strong, even violent, antivaccination movements, in the metropoles and in their overseas colonies. Antivaccination riots rocked Leicester, Montreal, and Rio de Janeiro. Since the 1870s American antivaccination leagues had challenged compulsory measures in the statehouses; after 1890, they began turning to the courts as well. Across the United States, citizens resisted public health authority by burning down pesthouses built in their neighborhoods, running away from vaccinators, fighting with police, forging vaccination certificates, or, perhaps most commonly, by quietly taking care of their sick loved ones in their own homes, instead of surrendering them to the authorities.60
American supporters of compulsory vaccination—including public health officials, the rising professional class of physicians, and the editorial writers for major newspapers such as The New York Times—often dismissed the opposition as an insignificant coterie of “imbecile cranks” who had fallen under the spell of foreign ideas. But the opposition was far more broad and complicated than that. It did not arise solely from a transatlantic critique of modern state medicine. Nor did it spring, fully formed, from American traditions of rugged individualism and constitutional liberty. The turn-of-the-century epidemics in particular would reveal that opposition to government-mandated smallpox vaccination grew up in the same soil from which had sprung compulsion itself: the conflict-laden realm of everyday social