Pox_ An American History - Michael Willrich [95]
FIVE
THE STABLE AND THE LABORATORY
Far from the battlefields of the nation’s first overseas colonial wars, American health officials on the U.S. mainland encountered rising resistance after 1900 to their own widening war on smallpox. The contentious politics of smallpox control centered on the growing divide between public health authorities and the public itself regarding the risks of vaccination.
Turn-of-the-century Americans lived in a world filled with risk. Each year one out of every fifty workers was killed on the job or disabled for at least four weeks due to a work accident. Railroad and streetcar accidents annually killed and maimed tens of thousands of people. Children worked in mines, stole rides on the back of moving cars, and played stickball in alleys carpeted with horse manure. Apart from a few things recognized by the courts as “imminently dangerous,” such as arsenic or nitroglycerin, product liability did not exist. The average American breadwinner carried just enough insurance to cover his own burial.1
During the first two decades of the twentieth century, a spate of new progressive social policies would create an enlarged role for the American government in managing the ordinary risks of modern urban-industrial life. The resulting “socialization” of risk, though narrow by the standards of Britain and Germany, was a dramatic departure for American institutions that prized individual freedom and responsibility. European-style social insurance gained traction in the first American workman’s compensation laws, enacted in forty-two states between 1911 and 1920. Mothers’ pension programs (launched in forty states during the same decade) provided aid to families that lost the wages of the “normal” (male) breadwinner due to his sudden death or disability. In tort law, too, the courts had women and children first in mind as they imposed tougher standards of liability upon railroad corporations. U.S. social politics still had a long way to go before a recognizably modern national welfare state insured its citizens against the financial insecurities of old age, or an American court seriously entertained the argument that an exploding Coke bottle entitled the injured party to compensation from the manufacturer. But the foundation was laid, in the social and political ferment of the Progressive Era, for a government that would one day promise its citizens “freedom from fear.”2
Arriving just as the American people and their policy makers began to seriously debate these issues, the turn-of-the-century smallpox epidemics raised broad public concerns about the quality and safety of the nation’s commercial vaccine supply. The ensuing controversy caused ordinary Americans, private physicians, and public officials to revise old expectations about risk and responsibility and the role of government in managing both.3
By the fall of 1901, the wave of American epidemics had carried small-pox to every state and territory in the union. The new mild type smallpox was the culprit in the majority of places, but deadly variola major struck several major American cities, particularly in the Northeast. Compulsory vaccination was the order of the day, enforced at the nation’s borders, in cities and towns, at workplaces, and, above all, in the public schools. The public policy was a boon to the vaccine industry, driving up demand for smallpox vaccine. American vaccine makers of the day ranged in size from rising national pharmaceutical firms such as