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Pox: An American History by Michael Willrich

Pox: An American History (edition 2012)

by Michael Willrich

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181665,444 (4.02)7
Title:Pox: An American History
Authors:Michael Willrich
Info:Penguin Books (2012), Edition: Reprint, Paperback, 432 pages
Collections:Your library

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Pox: An American History by Michael Willrich



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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. ( )
  rivkat | Jun 26, 2012 |
The story of Smallpox and vaccination in this country at the turn of the 20th Century. ( )
  AnneliM | Mar 26, 2012 |
A look at smallpox around the turn of the century, Pox explores the history of the disease and of vaccination, as well as the influence smallpox had on the role of government in public health. The subject matter itself is fascinating, in part because it is so sensational. The history of vaccination - and the horror stories accompanying it - are what I term "intellectually gruesome", meaning it's interesting on a brainy level while simultaneously appealing to the more basic need for blood, pus, and guts.

Despite my fascination with the subject though, I found myself getting a bit bored from time to time as Willrich piled a stack of facts too big for my small brain to process. At a few points, the accumulation of numbers, percentages and statistics, which were taking page space away from the more sensational anecdotes, had me setting the book aside. I don't want to give the impression, however, that it was some sort of prurient need for graphic nastiness which kept me from enjoying the more fact-based sections of the book. A larger part of the problem for me was the repetition of the same ideas - or the same story structure - throughout the book. I honestly believe the book could have been cut by many, many pages.

What kept me going though - and not skimming - was Willrich's writing. I really enjoyed his style, and at times found myself more interested in how he was constructing his sentences, in his word choice and pacing, than I was in what he was actually saying. Then the next super-interesting tidbit or anecdote would pop up, and I would once again be engrossed in the story. It was definitely a roller coaster ride of enjoyment. Some sections or chapters held my interest obsessively while others had my eyes glassing over.

My ultimate judgment is positive, and I would recommend this book to anyone interested at all in the subject. The sections of the novel which really engaged me were more prevalent than those which had me stifling a few yawns. ( )
  EclecticEccentric | May 1, 2011 |
My Review

Cover to cover, POX will command your attention with an unyielding grip. Who would think a history about the smallpox scourge would be so engaging, fascinating in fact?

Yet with his extensive research and well crafted narrative Willrich has accomplished that and more. When you read his book, the smallpox epidemic at the turn of the twentieth century is the focus. However, his look back prior to 1900, and then forward in time provides an important timeline and perspective. It is always interesting as a historian, to view the past with twenty-first century eyes. Fortunately, Willrich provides objectivity when writing of the past while offering opportunities to reflect and make connections to current issues facing our global community.

During the Progressive Era, social reformers were crusaders of change. Change is not always popular and Willrich points out those wishing to change current practice had their opposition. Vaccination proponents, favoring what was in their view necessary for the common good, argued with the opponents, the antivaccinationists who believed in a person’s individual rights.

POX provides a fluid chronicle of the smallpox virus and the development of the weapon that would ultimately obliterate it’s existence around the world. The methods state governments implemented to enforce vaccination was not always equitable. It is alarming to read, although it should not be a surprise that our country’s marginalized population suffered most. It was a common belief that this was a African Americans, recent immigrants, and the poor were systematically singled out and physically forced to submit to vaccination and/or quarantined within their homes or taken to pesthouses for weeks. Race, income, religion and political difference created a clear line of injustice and inequity.

POX will encourage deep reflection and inspire the curious. Michael Willrich has written a spectacular historical narrative, an outstanding read. POX has been added to my best picks for 2011.

© [Wisteria Leigh] and [Bookworm's Dinner], [2008-2011]. ( )
  WisteriaLeigh | Apr 20, 2011 |
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. ( )
  nbmars | Apr 19, 2011 |
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Chronicles how America's Progressive Era war on smallpox sparked one of the twentieth century's leading civil liberties battles, describing the views and tactics of anti-vaccine advocates who feared an increasingly large government.

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