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    Pox: An American History
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    Pox: An American History
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    Pox: An American History
    Audiobook14 hours

    Pox: An American History

    Written by Michael Willrich

    Narrated by K. Todd Freeman

    4/5

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    About this audiobook

    The untold story of how America's Progressive-era war on smallpox sparked one of the great civil liberties battles of the twentieth century.

    At the turn of the last century, a powerful smallpox epidemic swept the United States from coast to coast. The age-old disease spread swiftly through an increasingly interconnected American landscape: from southern tobacco plantations to the dense immigrant neighborhoods of northern cities to far-flung villages on the edges of the nascent American empire. In Pox, award-winning historian Michael Willrich offers a gripping chronicle of how the nation's continentwide fight against smallpox launched one of the most important civil liberties struggles of the twentieth century.

    At the dawn of the activist Progressive era and during a moment of great optimism about modern medicine, the government responded to the deadly epidemic by calling for universal compulsory vaccination. To enforce the law, public health authorities relied on quarantines, pesthouses, and "virus squads"-corps of doctors and club-wielding police. Though these measures eventually contained the disease, they also sparked a wave of popular resistance among Americans who perceived them as a threat to their health and to their rights.

    At the time, anti-vaccinationists were often dismissed as misguided cranks, but Willrich argues that they belonged to a wider legacy of American dissent that attended the rise of an increasingly powerful government. While a well-organized anti-vaccination movement sprang up during these years, many Americans resisted in subtler ways-by concealing sick family members or forging immunization certificates. Pox introduces us to memorable characters on both sides of the debate, from Henning Jacobson, a Swedish Lutheran minister whose battle against vaccination went all the way to the Supreme Court, to C. P. Wertenbaker, a federal surgeon who saw himself as a medical missionary combating a deadly-and preventable-disease.

    As Willrich suggests, many of the questions first raised by the Progressive-era antivaccination movement are still with us: How far should the government go to protect us from peril? What happens when the interests of public health collide with religious beliefs and personal conscience? In Pox, Willrich delivers a riveting tale about the clash of modern medicine, civil liberties, and government power at the turn of the last century that resonates powerfully today.
    LanguageEnglish
    PublisherPenguin Random House Audio
    Release dateMar 31, 2011
    ISBN9781101432471
    Unavailable
    Pox: An American History
    Author

    Michael Willrich

    Michael Willrich is the award-winning author of City of Courts. He is an associate professor of history at Brandeis University and a former journalist who wrote for The Washington Monthly, City Paper, The New Republic, and other magazines. He lives in Wellesley, Massachusetts.

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    Reviews for Pox

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    • 5/5
      Using smallpox vaccination as a case study, Willrich explores the broader progressive era movement in America (late 19th to early 20th century): the shift from liberty as an ideal specific to individuals to the gradual adoption of the idea of a social liberty (in an increasingly urbanized and interconnected society, the good of the many can trump the sovereignty of the individual). Decades have elapsed since the last variola major outbreak (significantly more deadly form of the smallpox virus), leaving the general population largely unvaccinated and unaware/unconcerned with its particular horrors. Fledgling health departments across the country have identified the reappearance of the disease and issue mandatory vaccination orders to curb its devastation. Unsurprisingly, there's a strong class divide in enforcement: the rich/influential are taken at their word that they've been recently vaccinated while the poor/immigrant/black populace is vaccinated by a growing police force if they neglect to volunteer. Contributing to the populace's increased resistance to vaccination: the majority of the cases during this time period are variola minor (significantly less deadly, although no less contagious, than its major counterpart), the impurity of the vaccine (local/state governments have NO quality control over the vaccines they mandate upon their citizens resulting in horrific side effects/death from opportunist assholes, most notably the Camden tetanus/lockjaw deaths - primarily affecting children), the lack of compensation/recourse for missed work/injury due to vaccination side effects, and the authorities' insistence that vaccination is indisputably safe. Medical professionals point to countries like Germany and Sweden where smallpox vaccination is near universal and their consequent success at having eliminated the devastating disease. Also to domestic cases where large-scale vaccination efforts successfully halt growing epidemics.Anti-vaccinationists use their growing platform to decry the vast increase of police force/reach into their communities and the growing intrusion of government into their homes/bodies (as many public schools mandate vaccination of their pupils/staff or bar entry). The federal government is also gaining power via the greater good health argument requiring vaccination as a prerequisite for entry to the nation and launching wide-scale vaccination campaigns in its military holdings (i.e. the Philippines). Compulsory vaccination is often equated with war, officials have the right to defend their borders and protect their people against an insurgent (disease). Several state supreme courts uphold compulsory vaccination laws/edicts during outbreaks, yet recognize and prohibit excessive police force and allow for exceptions for unfit children. Eventually the federal supreme court rules in Jacobson v. Massachusetts (1905) that compulsory vaccination is legal, but limits excessive police force and requires that exceptions be made for both adults and children that are unfit to undergo the procedure. Setting a standard in the argument of individual v. social liberty:"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. But it is equally true that in every well-ordered society charged with the duty of conserving the safety of its members the rights of the individual in respect of his liberty may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations, as the safety of the general public may demand." (Justice Harlan writing for the majority)Via compulsory vaccination, smallpox is eventually eradicated in the United States and throughout most of the world. The author cautions that scientific health advancements need to be tempered with education programs and intelligent/compassionate enactment in order to prevent the blunders of the past. Vaccination in theory is a powerful weapon against debilitating, contagious disease - its execution by fallible humanity wants improvement.Cannot handle the level of interesting this compendium holds and pathways I now have to explore.
    • 4/5
      When did the current controversy about vaccines really start? According to Willrich’s history, the controversy about vaccines started all the way back with Jenner’s discovery of vaccination. Although smallpox once killed thousands of people each year in America, vaccination against smallpox was still controversial. A small fraction of people had adverse reactions, including death.

      Obviously, this scared people. It especially scared those who were in oppressed groups, like blacks in the American South. This book tells their story in a greater narrative of how science and popular belief tried – again and again – to reconcile to each other.

      The resolution of Willrich’s tale lies with the Supreme Court case of Jacobson v. Massachusetts in 1905. In the final chapter, he masterfully brings out the drama and nuance of this case. (If this book consisted of just that very chapter, it would be worth reading.) In the decision, SCOTUS upheld the rights of states to force vaccination, but in tension, it also upheld the right for people with real beliefs (not just “obstinacy”) to decline forced vaccination.

      This book is worth reading for those with medical or historical interests. It also provides a worthy pericope into popular American history. In contemporary culture where science can sometimes become overbearing, this story reminds us that “scientific triumphalism” and “antiscientific denialism” are really two sides of the same coin.

    • 5/5
      How smallpox shaped the American public health system, both by accustoming public health authorities to mandatory vaccination, sometimes at gunpoint, and often convincing groups of Americans to resist it, sometimes even violently. (One thing reading this very near to finishing the Pinker book made me think is how much less violent today’s vaccinators and antivaccinators are.) Some things don’t change: like today’s legislators voting not to acknowledge sea level rise, a county worried about the economic impact of quarantine/vaccination voted that there was no smallpox in the county. Also, as with health care reform, there was always great capitalist involvement: mandatory vaccination turned out to bolster the bottom line of drug companies, something that made opponents suspicious; government production was barely tried even as government regulation came to seem more and more important given the dangers of bad vaccine.Any topic in US history has its racial component: Immigrants arriving in New York were required to be vaccinated—except if they came over in first or second class; the same thing happened at the Mexican border, where all second- and third-class passengers needed recent vaccination scars to get through, but Pullman passengers could swear to their immunity. Likewise, whites in the South often discounted the risks of smallpox because they thought that only blacks would get it; Willrich points out that this speaks to greater physical segregation in the late 19th-century South than is often imagined, but also notes that white Southerners were routinely disappointed in their imaginings that whites were more resistant.A chapter on vaccination in the Phillippines situates vaccination within the imperial project, and draws out the connections between progressivism and imperialism. It also contains the great line “Forget the Maine.” (He continues: “In Hoff’s [one of the public health officials important in the book] decidedly contrarian view, the Spanish-American War was decidedly a police action, taken against a delinquent neighbor that had allowed its properties to overflow with yellow fever and smallpox.”) Willrich also argues that vaccination lawsuits gave the Supreme Court the language of “clear and present danger” later used in First Amendment doctrine, as well as providing a rationale for later eugenic projects. Overall, the book is an engaging account of an important episode in American progressivism.
    • 4/5
      Michael Willrich’s Pox is a history of the fight against smallpox near the end of the 19th century in the United States. In particular, it emphasizes the resistance to vaccination by a large segment of the American public, and the redefinition of liberty that ensued from the conflict.At that time, prior to any regulation of the biologics industry, the manufacture of vaccines lacked quality control, and their use carried the risk of pain, disfigurement, and even death from contaminated material. Vaccine samples “crawled” with bacteria, sometimes spreading syphilis or tetanus. Moreover, many people feared compulsory removal to “pesthouses,” and rightly so, since conditions there were abhorrent, and in any event, only the lower classes were forced there for isolation. Other factors contributing to resistance included medical beliefs, religious tenets, parents’ insistence on their rights to govern their own children, and “dearly held notions of personal liberty.” Because smallpox outbreaks usually began in black communities (owing to the poverty, crowding, racism by the health care profession who often refused to treat blacks, and the itinerant nature of many blacks looking for work), whites did not want to undergo vaccination for what they perceived to be a black disease, nor did they want to use their tax money to subsidize a vaccine. Blacks themselves particularly resisted vaccination, as did recent immigrants to the U.S., since they did not trust the authorities. Another complicating issue was the fact that there were two types of smallpox: the classic, dangerous smallpox, or variola major, and a mild variety, variola minor, which was not life-threatening. In the case of the latter, the vaccine could pose more risk than the disease itself.Because of all the resistance, coupled with the medical profession’s awareness of the danger of the disease, force was often used to check for evidence of, and administer, the vaccines. (Some local doctors made matters worse by accepting bribes to provide vaccination certificates; therefore only the vaccine scar was accepted as proof of vaccination.) Blacks in particular were likely to be roughed up--many were handcuffed and vaccinated at gunpoint. And in a precedent-setting development, federal health officials persuaded many employers to deny work in cases of noncompliance. Willrich observes that this may have laid the foundation for future agreements to control labor conditions. The most interesting part of the story, in my opinion, is the battle that ensued in the courts about where the line should be drawn between the states’ inherent “police power” and individual liberty, and indeed how personal liberty would be defined in the changing culture of the nation. Some contend this fight affected the fate of our country as much as the Revolution or the Civil War: what limits should apply to new laws and restrictions governing the fields of social and economic regulation? What was the extent of fundamental individual liberties? Does the state ever have the right to encroach on the inviolability and integrity of a citizen’s body? How should the modern state balance liberty of the individual against the greater good of society? When is “clear and present danger” adequate justification for an increase in police power by the state?The cases brought by citizens against compulsory vaccination, and in particular, Jacobson v. Massachusetts (197 U.S. 11, 1905), set standards still invoked today for an understanding of liberty in America. The defendants challenged the state’s attempt to compel them to accept vaccination as a violation of their 14th Amendment right to liberty without “due process of law.” (The state’s jurisdiction was not questioned; rather, the question put to the Court was whether the state had overstepped its own authority.) In upholding the state’s power to compel vaccination, Justice John Marshall Harlan wrote:"[T]he liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. On any other basis, organized society could not exist with safety to its members. Society based on the rule that each one is a law unto himself would soon be confronted with disorder and anarchy. Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others. [my emphasis]"He also added a caveat, however:"…it might be that an acknowledged power of a local community to protect itself against an epidemic threatening the safety of all, might be exercised in particular circumstances and in reference to particular persons in such an arbitrary, unreasonable manner, or might go so far beyond what was reasonably required for the safety of the public, as to authorize or compel the courts to interfere for the protection of such persons. …Extreme cases can be readily suggested. Ordinarily such cases are not safe guides in the administration of the law. … We are not to be understood as holding that the statute was intended to be applied to such a case, or, if it as so intended, that the judiciary would not be competent to interfere and protect the health and life of the individual concerned. 'All laws,' this court has said, 'should receive a sensible construction. General terms should be so limited in their application as not to lead to injustice, oppression or absurd consequence. It will always, therefore, be presumed that the legislature intended exceptions to its language which would avoid results of that character. The reason of the law in such cases should prevail over its letter.'"The Jacobson ruling had wide ramifications and was hailed both by those in favor of an expansive police power and by those who emphasized civil liberties. However, a few months later, the Court seemed to reverse itself with its ruling in the famous case Lochner v. New York (198 U.S. 45, 1905). (Justice Rufus Peckham wrote the opinion; Justice Harlan along with Justice Oliver Wendell Holmes, Jr. filed dissents.) Lochner juxtaposed the right of private businesses to set up any kind of contracts they wanted against the concerns of bakers for their health and welfare. The Court found that the police power did not extend to the power to interfere with private contracts (even on the ground of seemingly sound public policy), insofar as, it opined, health hazards are often just a natural part of life, rather than a function of conditions that can be manipulated by employers. Over the next three decades, the Court employed the Lochner doctrine of "liberty of contract" to strike down numerous attempts by state governments to exercise their police power to improve working conditions or protect consumers. In other words, while Jacobson expanded police power in some circumstances, Lochner went the other direction.Nevertheless, Willrich contends that many legal scholars continued to look to Jacobson rather than Lochner as “the authoritative statement of the almost unlimited extent of the police power in the United States.” The ensuing battle between substantive and procedural interpretation of the 14th Amendment did not end until the late 1930’s when the Court endorsed Franklin Roosevelt’s regulatory priorities. [The phrase “substantive due process” is often used to describe the Court’s approach with Lochner and similar cases of that era, using the due process clause of the 5th or 14th amendments to invalidate the substance of legislation rather than merely the procedures embodied therein or those used to enact it.]Willrich observes that Jacobson has been cited as precedent numerous times in Supreme Court cases to defend extraordinary exercises of government power, including sterilization laws and warrantless entry. It has also, however, provided authority for the revolution in civil rights, especially with respect to bodily autonomy and integrity, as in cases of reproductive rights and medical privacy.Evaluation: This is a fascinating and timely story not often told about the behavior of both the government and the public in the face of a widespread biological threat, and about the evolution of law that arose because of it. While the specifics of the smallpox epidemic provided more information than I may have preferred, I applaud the author’s meticulous documentation. On the other hand, while I can read about the Fourteenth Amendment all day long, some other readers might think that section of the book too detailed. In sum though, I would say this book has something to interest a wide variety of readers, and is a worthy contribution to our historical record.
    • 4/5
      Although now extinct, during the late 1890s and early 1900s, smallpox, also known as the variola virus, was a widely feared and extremely destructive disease that made its virulent way across America and abroad. As smallpox cases, beginning in the south, raged across the country, new and terrifying measures were taken to stop the spread of the disease and to inoculate the population. But resistance to the new procedures forced American lawmakers, scientists and doctors to become more aggressive in their tactics, forcing citizens into compulsory vaccinations that were fought with violence and hatred, and sometimes even resulted in court cases. Over many years and across many continents, compulsory vaccination spread its vicious claws, effectively turning the American government into a police state, at least where the issue of small pox was concerned. In this revealing portrait of the disease, Michael Willrich exposes not only the very serious and possibly fatal consequences of smallpox, but of the revolutionary zeal with which the American government went to war with this most heinous of diseases. Incorporating statistics, personal reflections, photographs and impeccable research, Willrich gives his readers a comprehensive overview of the history of smallpox from its first serious outbreak to its final abatement. The struggle against this horrible disease is captured here, in all its terrifying reality and implications.From the earliest infestations of smallpox, leading medical authorities mistakenly believed that the disease was caused by unhygienic practices, which led to utter confusion when trying to stamp out epidemics. The real cause of smallpox is an incredibly robust virus, able to disperse itself through various measures. Scientists and physicians had been on the wrong track for a long time. When scientists discovered that by scratching the live smallpox virus into the skin of the arm, the patient could actually be vaccinated against the virus, smallpox abatement became the order of the day, and governmental officials sought to vaccinate every man, woman and child in America.But the effects of the vaccination were sometimes painful, and due to the inability to sterilize the virus before use as a vaccine, the vaccinations sometimes caused other infections, such as syphilis and tetanus. Public outcry against vaccination became the norm, and anti-vaccination leagues began to rage In many cases. Compulsory vaccination became like warfare, with those objecting being forced to comply at gunpoint or being fined and thrown in jail. No American was spared, and often children were turned away from schools, and men and women from labor, if they could not show the telltale vaccination scar.Pesthouses, where those ill with smallpox could recover, began to be built in areas of each city, much to the dismay of the surrounding population, and vaccination was carried into the Spanish and Philippine wars, not only for the soldiers, but for the natives as well. Compulsion became coercion and violence in these instances, and the rights of the people to refuse vaccination were summarily dismissed. Quality control of the vaccines became a problem again and again, with many people suffering dreaded diseases after their vaccinations. In one stunning display, tens of schoolchildren died of tetanus after being vaccinated by a tainted batch of smallpox vaccine. Smallpox vaccination engendered heated discussion among professionals as well as laypersons, and as the right to refuse vaccination flew away, more and more opposition began to grow. In effect, the government of the United States had decided to act in the welfare of all of its citizens by enforcing vaccination in every case. In its first real skirmish against the American people themselves, the government won, and it changed the way that individual liberties would be shaped from that time until today.This book was extremely informative but I couldn't help feeling a little overwhelmed with all the information presented. There were sections that were much more interesting than others, particularly those sections on germ theory and the information about vaccine production and purity. Other sections that dealt more heavily with wartime vaccinations and court battles were somewhat dry, which created a feeling of unbalance in the scope of my reading. Considering that this was a very controversial and lengthy issue, the book was sometimes weighed down by its own preponderance of information, though there were times when I read compulsively and avidly. The book was greatly informational about all the aspects of smallpox, from the domestic and governmental issues to the medical and legal issues, but a lot of this information seemed a little too tightly packed for casual reading. Smallpox certainly created some interesting conundrums in the area of contagion management, civil liberties and medical ethics, and I think Willrich did an impressive job of explaining it all to an audience that may never before have thought of the kinds of problems that a smallpox epidemic would raise.Though the book was weighty and dense, it was written with a solid foundation in research and with a truly inquisitive style that elevated it beyond what I would have considered it to be. It might not be concise, but those looking for a well rounded book that exposes the many sides of the smallpox issue would do well to pick this one up and give it a try. Ambitious in its scope, this book delivers in ways that you might not expect.