Social Life of Disease - Smallpox

Pox: An American History (2011) by Willrich provides a wealth of interesting examples of the intersections between public health, epidemiology, society, culture and politics.

The context:

• "All told, during the five-year wave of epidemics around the turn of the century, the federal service counted 164,283 American cases of smallpox. The actual number of cases may have exceeded five times that figure. But for American public health officials, the truly stunning statistic was the body count. It was shockingly low. According to the federal health service reports, only 5,627 people died … If smallpox had measured up to its historical virulence, the epidemics of 1898-1903 would have killed at least 50,000." (p. 11)
  
• "America's turn-of-the-century war against smallpox sparked one of the most important civil liberties struggles of the twentieth century." (p. 14)
  

On the social life of disease:

• "African Americans in the Over the Rhine district learned how a smallpox epidemic could transform years of official indifference and neglect into coercion and violence. Racial tensions had risen during the winter, as white officials and newspapers blamed black townsfolk for the events that brought shame on the community. The Weekly Record called for a public law, like the Louisiana separate coach law the U.S. Supreme Court had upheld in Plessy v. Ferguson (1896), to "keep the colored people in a separate section of the town. If it cannot be done by process of law, it can be accomplished by public sentiment."" (p. 58)
• "The scarless arms of those nine children of the Italian diaspora tell us something about their political status. Each was, in the words of the Constitution, a "natural born Citizen" of the United States. How could a child's skin say so much? In the final years of the nineteenth century, in the midst of the greatest sustained wave of human migration the world had ever seen, a vaccination scar had become something more than a sign of immunity from smallpox. The scar has become a sort of passport – a stamp-sized tattoo of a political immunity, required by U.S. law and the quarantine regulations of the nation's major ports for entry into the American body politic. This legal requirement did not apply with equal force to all. The class-based spatial arrangements of the ocean voyage governed migrants' treatment upon arrival…" (p. 216-217)
  
• "In a broader sense, the history of America's turn-of-the-century fight against smallpox cautions us against making reflexive judgments about the innumerable people, the world over, who greet scientific innovation and expert authority with skepticism, resentment, or steadfast resistance. To dismiss so many people as merely ignorant and irrational is worse than intolerant… Unthinking scientific triumphalism is no sounder an approach than antiscientific denialism to the social conflict and political contention that are likely to continue to haunt the human quest to make ours a healthier world." (p.344-345)
  

On opposing vaccines and vaccinations:

• "… reasonable health concerns do not alone explain the widespread opposition to compulsory vaccination at the turn of the twentieth century. Antivaccinationism was an international phenomenon, but everywhere it reflected the social divisions and political tensions of its time and place. The roots of American antivaccination sentiment ran deep and wide. Race stymied smallpox control, as white taxpayers, particularly in the South, balked at paying for vaccine to protect blacks; meanwhile, African Americans rightly mistrusted government vaccinators whose chief aim was to protect the white community. Christian Scientists viewed compulsory vaccination as a violation of religious freedom. Physicians who practiced popular forms of alternative medicine decried government vaccination orders as yet another example of creeping "state medicine." Parents resented school vaccination mandates for encroaching on their domestic authority and for violating children's innocent bodies. Antivaccination propagandists traced compulsory vaccination to a corrupt conspiracy between health officials, lawmakers, and vaccine manufacturers. On the broadest level, though, the vaccination question revealed a sharp uneasiness toward the authority of medicine and the power of the state at the height of the Progressive Era, a period of time when both institutions were reaching more ambitiously than ever before…" (p. 12-13)
  
• "Many antivaccinationists had close intellectual and personal ties to a largely forgotten American tradition and subculture of libertarian radicalism. That tradition took on a feverish new life as industrial capitalism, progressive reform, and the professionalization of knowledge fostered the rise of a distinctly modern interventionist state during the Progressive Era. The same men and women who joined antivaccination leagues tended to throw themselves into other maligned causes of their era, including anti-imperialism, women's rights, antivivisection, vegetarianism, Henry George's single tax, the fight against government censorship of "obscene" materials (under the late nineteenth century "Comstock laws"), and opposition to state eugenics." (p. 252-253)