Nineteenth century cities were notably unhealthy places, rife with all sorts of infectious diseases. Tuberculosis was the leading cause of death in Cambridge at the beginning of the 20th century, but significant numbers died in periodic epidemics of diphtheria, typhoid, scarlet fever, malaria, and measles – all nearly forgotten today. However, none of these caused greater fear than smallpox, a highly communicable virus that killed as many as 60% of those it infected and often left the survivors badly scarred.
[Sickbed with pox victim and text with decorated initials]. Frontispiece and text in: Een excellent tracktaet leerende hoemen alle ghebreken der pocken sal moghen ghensen / Paracelsus. Thantwerpen : Thantwerpen : Gheprint by J. Poelants, 1553.
Smallpox originated in Asia in the third century CE. European explorers carried it to the new world, where it caused the death of entire local populations – including an estimated 90% of the Native Americans in Massachusetts Bay in 1617-19. An outbreak in Boston in 1721 infected over 5,000 people, of whom 844 died, and epidemics recurred in 1730, 1751, and 1776-78. Cambridge’s Dr. Benjamin Waterhouse introduced Dr. Edward Jenner’s improved smallpox vaccine to America in 1800, but inoculation seemed counter-intuitive to most people and was never common. (During this period Waterhouse supplied Thomas Jefferson with enough to protect his family and two hundred slaves.)
Waterhouse, Benjamin, 1754-1846, “Letter from Benjamin Waterhouse to Edward Jenner,” OnView: Digital Collections & Exhibits, http://collections.countway.harvard.edu/onview/items/show/6624. In this letter, Waterhouse describes for Jenner the difficulties he has encountered with inoculations of spurious matter and asks for some additional vaccine, specifying that the matter be sent on soaked threads pressed between glass and sealed with wax.
An outbreak of smallpox that struck Cambridge in 1872 and 1873 infected 290 people, of whom 57 died. The city offered free vaccinations and isolated infected persons at the almshouse, and eventually these measures prevailed. The next epidemic originated in Boston in 1901 and struck with much greater force. Cambridge’s first case was reported in October, and this time the city’s new Board of Health swung into action with an aggressive campaign of mandatory isolation of infected individuals, vaccination of everyone living in neighboring houses for the distance of a city block, and fumigation of the infected premises with formaldehyde gas. The city did not attempt to quarantine well persons because such measures were too difficult to enforce; at the mere rumor of a quarantine the inhabitants would scatter; if they were left in place their health could be monitored. Active patients were isolated as far as possible from populated areas in three houses on New Street that the city took by eminent domain expressly to serve as a temporary “detention hospital.”
View of “The New Almshouse” published in the Cambridge Chronicle, 22 March 1851
Free city-wide vaccination clinics were not sufficient, and in March 1902 the Board of Health ordered that all inhabitants of the densely settled neighborhoods in the eastern part of the city who had not been successfully immunized within the previous five years had to submit to vaccination. Teams of doctors went from house to house and vaccinated everyone they could find. Libraries, schools, and churches were closed in June. During the summer, doctors accompanied by police officers visited every house in the city, and anyone who could not produce evidence of vaccination or refused to be vaccinated was summoned to court.
By August 18th, 1902, the incubation period for new cases had passed, and the epidemic was over. In all, Cambridge doctors vaccinated 56,213 persons over a ten-month period. Of the reported 192 people infected, 32 died. By comparison, Boston reported 1,596 cases; in both cities, the mortality rate was about 17%.
The city burned down the houses on New Street in 1906, and the epidemic passed into history as the last major smallpox outbreak in the United States. However, memory of the episode survives in the landmark case of Jacobson v. Massachusetts, in which the U.S. Supreme Court upheld the ability of the City of Cambridge to require citizens to submit to vaccination.
Detail of New Street on 1903 and 1916 Cambridge Bromley Atlases.
The case was brought by Rev. Henning Jacobson, Assistant City Clerk Albert Pear, and two others who refused to be vaccinated. Rev. Jacobson, who was pastor of the Augustana Lutheran Church, refused for religious reasons, while Pear produced a note from his doctor exempting him on medical grounds. The Cambridge District Court judge was not swayed and fined each man $5.00. The Massachusetts Anti-Vaccination League took up their case; when the Supreme Judicial Court ruled against the men, the league supported their appeal to the U.S. Supreme Court. In a unanimous decision, Justice John M. Harlan confirmed that: “Upon the principle of self-defense, a community has the right to protect itself against an epidemic of disease which threatens the safety of its members” [Jacobson v. Massachusetts, 197 U.S. 11 (1905)].
The authors of an article published in the February 17, 2005, issue of The New England Journal of Medicine state: Rejecting the contention that mandatory vaccination violated an individual’s right to due process and equal protection as guaranteed by the 14th Amendment of the Constitution, the Court held that states may limit individual liberty in the service of well-established public health interventions. For 100 years, this seminal opinion has served as the constitutional foundation for state actions limiting liberty in the name of public health. (Parmet et al., N.E. Journal of Medicine 352:7)I
Terrific post. As usual. So mich information I didn’t know.