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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 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.


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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 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.

30 review for Pox: An American History

  1. 5 out of 5

    Judith

    Thrilling read, seriously. I learned so much history: of pox, the development of public health oversight, the development of consumer affairs, the rift between individual liberties vs. social good, and more. Powerfully important stuff that more people should know.

  2. 5 out of 5

    Ashley

    I simply loved this book. Willrich does an incredible job blending legal, public health, and cultural history. He manages to be critical of the Progressive Era without sounding anti-reform or anti-progress. In particular, I appreciated the way he talked about the relationship between the post-Civil War society and smallpox vaccination as a social, rather than medical, issue. The information about how the US used vaccination as a tool of empire/war was also new to me and Willrich's insights are v I simply loved this book. Willrich does an incredible job blending legal, public health, and cultural history. He manages to be critical of the Progressive Era without sounding anti-reform or anti-progress. In particular, I appreciated the way he talked about the relationship between the post-Civil War society and smallpox vaccination as a social, rather than medical, issue. The information about how the US used vaccination as a tool of empire/war was also new to me and Willrich's insights are very thought provoking. I cannot tell you how often I wrote a "!" in the margin or flipped to the back to write a note to myself. The book is incredibly well researched and organized. Although there were a lot of names and places to keep up with, I never found myself (too) confused or lost. I cannot recommend this book enough to someone who wants to learn more about public health's early days, the early anti-vaccine movement, or the Progressive era. It is not the quickest read, but it is well worth your time.

  3. 4 out of 5

    Trisha

    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, a 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.

  4. 5 out of 5

    Lauren orso

    I wanted Ghost Map and I got a textbook. The founding of public health, early antivaccinationism and all the race/class aspects of vaccinations were really interesting, but oh my god this was a slog

  5. 5 out of 5

    Porter Broyles

    It's the fourth book on plagues I've read this year (the first one I read before we knew about COVID). Of the four, this might be the most relevant to what is going on in the world right now. The book is broken into different phases: Phase 1: Origins and Blame While Small Pox has been around for centuries, when it popped up in the US in the 1890s, most people were not worried about it. The disease wasn’t identified for what it was and was considered a black disease. While reading the first 20% of t It's the fourth book on plagues I've read this year (the first one I read before we knew about COVID). Of the four, this might be the most relevant to what is going on in the world right now. The book is broken into different phases: Phase 1: Origins and Blame While Small Pox has been around for centuries, when it popped up in the US in the 1890s, most people were not worried about it. The disease wasn’t identified for what it was and was considered a black disease. While reading the first 20% of this book, I thought it would end up on my black-history shelf. The authorities told white Americans that they did not have to worry about it. As it spread, the black community was blamed. Non-whites who caught it were thought to have caught it from black people. Phase 2: Spread Because the authorities didn’t recognize it for what it was, the disease spread. As a result of the Spanish-Mexican War Americans took it to the Philippines and Cuba. This section was fairly short and my least favorite. Phase 3: Containment When the disease was recognized, the authorities started to use different mechanisms to contain the disease. This involved two major avenues of attack: First, Small Pox vaccinations was one of the first illnesses for which there was a vaccine. Americans were pretty reluctant to getting vaccines. While other countries had laws on the books requiring people to get vaccines, the United States had anti-vaxers! The Anti-Vaccination Movement in the US predates the first American Vaccine! The US passed laws and started to require vaccines. Immigrants couldn’t enter the US unless they showed physical proof of having the disease (the poxes) or could prove they were immunized (either the scar or a letter from their doctor saying they had received the shot.) Needless to say, anti-vaxers found ways around both of those requirements (disfuring themselves to look like had the shots or getting a ‘doctor’ to lie.) Second, quarantines and shutting down of businesses. This was a period wherein federal, state, and local governments started to flex their muscle to squelch the spread of small pox. Businesses could not be open if they employed more than 5 people unless they had all received a vaccine (as proved above.) People couldn’t travel unless they could prove their vaccination status (particularly enforced on blacks and immigrants). People couldn’t enter the country unless they were vaccinated first. Ships started forcing passengers to get the vaccine before they arrived in the US. Governments starting quarantining areas and businesses where pox out breaks were discovered. Phase 4: Resistance This section was my absolute favorite parts of the book. It talks about the early development of the anti-vaxer movement and how due to non-existent regulation concerning vaccinations (literally anybody who owned a cow could produce the vaccine) problems arose from some vaccines. Including one location which experienced numerous deaths due to cross contamination. One of the more interesting stories centered around the head of public health making a challenge to the anti-vaxers to prove they didn’t need the vaccine—eg to expose themselves. He did not expect somebody to take him up on the challenge… what happened… I won’t tell you. Phase 5: Court After the plague there were scores of legal cases concerning all of the aspects that the Government took. John Marshal Harlan and Oliver Wendell Holmes are quoted extensively in this section (apparently despite their both being remembered as progressive Justices, they didn’t always see eye to eye.) This book rises above the others because it spends a fair amount of time covering the diachotomy between Government responsibility to protect the people and individual freedoms. (Many of the ideas which we hold today about freedom rose during these cases!)

  6. 5 out of 5

    Laura

    To what lengths may the state go in order to protect the public health? As an American born near the end of the twentieth century and the daughter of scientifically-minded parents, I'm used to thinking of vaccines as an unqualified positive development and the major factor that protects us today from diseases like measles and diphtheria. I started this book on the side of vaccinators, rooting for measures that would increase the vaccination rate and limit the effect of inevitable smallpox epidemi To what lengths may the state go in order to protect the public health? As an American born near the end of the twentieth century and the daughter of scientifically-minded parents, I'm used to thinking of vaccines as an unqualified positive development and the major factor that protects us today from diseases like measles and diphtheria. I started this book on the side of vaccinators, rooting for measures that would increase the vaccination rate and limit the effect of inevitable smallpox epidemics. As I learned about the dark side of smallpox vaccination, my initially unqualified support became pockmarked with doubt. The vaccine itself had a well-earned reputation for causing illness, temporary disability, or even death. (Even today, smallpox vaccine is not considered terribly safe.) A lack of any manufacturing regulations at the turn of the twentieth century led to shoddy quality of vaccine and a number of children contracting lethal tetanus after vaccination. Sometimes-brutal compulsory vaccination campaigns for adults almost exclusively targeted poor, immigrant, and/or black communities. Smallpox led to the beginnings of federal disease control and prevention (CDC) and modern pharmaceutical controls (FDA). Perhaps more importantly, the legal conflict between the ideal of personal liberty (in this case, the liberty to control the substances that enter one's own body) and the reality of modern, urban, industrial life (where one's personal decision not to be vaccinated could expose hundreds or thousands of other people to the risk of disease and death) was one of the factors that shaped progressive thought and led eventually to the New Deal. And I, who was so sure of vaccination when I started the book, am no longer certain of what choice I would have made if I were born a century earlier.

  7. 5 out of 5

    Dee Eisel

    This is a history book and makes no pretense of being anything else. It is not trying to tell a story. It is trying to recount and link facts into a larger picture. It succeeds, but at the price of being a bit on the dry side. This will lose some readers, but if you stick it out you will end up with a much clearer picture of an era rapidly slipping into our culture's memory hole. The smallpox vaccination scare of the Bush years itself is already fading from memory, so smallpox itself seems like This is a history book and makes no pretense of being anything else. It is not trying to tell a story. It is trying to recount and link facts into a larger picture. It succeeds, but at the price of being a bit on the dry side. This will lose some readers, but if you stick it out you will end up with a much clearer picture of an era rapidly slipping into our culture's memory hole. The smallpox vaccination scare of the Bush years itself is already fading from memory, so smallpox itself seems like something made up to scare children. One of the book's main points is that even in 1900, the major epidemics were already in the past. People who have never seen the suffering these diseases can cause discount them easily, but the government cannot afford to forget. As a result, the state went to extreme lengths to ensure compliance with vaccination laws. We cannot afford to forget that either. I found the latter section, with its focus on antivaxxers of the 1900s, to be illuminating in looking at the antivaxxers of today. In particular, the events in Camden, NJ shine a light on the thimerosol freakout of the antivax movement of today. It's a good read for those who appreciate the weaving together of webs of facts as much as the telling of a story. I can't recommend it to those who need the story element for enjoyment of a history.

  8. 4 out of 5

    Ariel

    This book is incredible. Sure I'm a sucker for turn of the century anything but this book is way more than that. What is incredible about it to me is that it is written with the ease and accessibility of a typical journalist written non-fiction book, but with the nuance and argument of an academic book. The book doesn't just trace the history of smallpox in America, it focuses in on a very important time for the formation of progressive ideas, the nation state, and American society and shows how This book is incredible. Sure I'm a sucker for turn of the century anything but this book is way more than that. What is incredible about it to me is that it is written with the ease and accessibility of a typical journalist written non-fiction book, but with the nuance and argument of an academic book. The book doesn't just trace the history of smallpox in America, it focuses in on a very important time for the formation of progressive ideas, the nation state, and American society and shows how vaccination was integrally tied to all of them. The author does an amazing job of showing how the arguments of today are not just reformulations of arguments of the past. The very question of whether vaccination was or was not a progressive ideal is very knotty and I found myself thinking about just why certain opinions today belong to one side or the other of the current political spectrum in new ways. Read this book- you will better understand our country and its history.

  9. 4 out of 5

    Tomi

    It really didn't take that long to read this - the book just got lost in the piles of books around my bed! This was a very interesting study of America's last smallpox epidemic and the fight over vaccinations. An appropriate read for this time, what with the fears of an Ebola epidemic, the discussion of what to do with people exposed to Ebola, and the talk about vaccinations possibly causing autism, etc. The book is well-written and easy to read and understand - even the science parts, which are It really didn't take that long to read this - the book just got lost in the piles of books around my bed! This was a very interesting study of America's last smallpox epidemic and the fight over vaccinations. An appropriate read for this time, what with the fears of an Ebola epidemic, the discussion of what to do with people exposed to Ebola, and the talk about vaccinations possibly causing autism, etc. The book is well-written and easy to read and understand - even the science parts, which are always a challenge for me!

  10. 5 out of 5

    Ash

    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), 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.

  11. 5 out of 5

    Rob Lund

    Pox read like a text book. It was dry, very long, but very exhaustive on the history of smallpox as a viral infection as well as social challenge. I found the portions dealing with early race relations as it regards infectious diseases fascinating and troubling. The latter third was also very illuminating. I had no idea just how deeply rooted the American anti-vaccination movement was. It hails from the early faith healers, Christian science, mesmerism, and of course libertarian conspiratorialists Pox read like a text book. It was dry, very long, but very exhaustive on the history of smallpox as a viral infection as well as social challenge. I found the portions dealing with early race relations as it regards infectious diseases fascinating and troubling. The latter third was also very illuminating. I had no idea just how deeply rooted the American anti-vaccination movement was. It hails from the early faith healers, Christian science, mesmerism, and of course libertarian conspiratorialists. The book shows well the tenuous relationship between public health safety via compulsory vaccines and the staunch philosophies of civil liberty. It's really a wonder that America survived the pox epidemic at all.

  12. 4 out of 5

    Dixie Diamond

    Lot of interesting information, but the slanted perspective and obnoxious loaded language make it hard to read and make me trust the author less. This was the end of the 19th century: Medicine barely grasped germ theory. The author's admiration of anti-vaccinators no longer makes sense *over a hundred years later* when vaccines are far more advanced and safer. In that regard, we are not in the same situation as we were in 1899. (And I say this as someone with a close relative who is immune suppre Lot of interesting information, but the slanted perspective and obnoxious loaded language make it hard to read and make me trust the author less. This was the end of the 19th century: Medicine barely grasped germ theory. The author's admiration of anti-vaccinators no longer makes sense *over a hundred years later* when vaccines are far more advanced and safer. In that regard, we are not in the same situation as we were in 1899. (And I say this as someone with a close relative who is immune suppressed and has no choice but to depend on herd immunity for protection, which is why I get flu shots even though they make me feel like crud for awhile.)

  13. 4 out of 5

    Diana

    I expeced this book to be about the history of smallpox in the US, when the epidemics hit, how they treated people, etc. What this book ended up being about was the vaccination against smallpox, and the Anti-Vaccination movement in American in the early 1900's. The thing I liked most about this book was learning that parents worrying about the side effects of their childrens vaccines is nothing new. That's the only thing that made the book interesting for me, which is sad because I've had this b I expeced this book to be about the history of smallpox in the US, when the epidemics hit, how they treated people, etc. What this book ended up being about was the vaccination against smallpox, and the Anti-Vaccination movement in American in the early 1900's. The thing I liked most about this book was learning that parents worrying about the side effects of their childrens vaccines is nothing new. That's the only thing that made the book interesting for me, which is sad because I've had this book on my shelf for a long time and was looking forward to reading it.

  14. 4 out of 5

    Kristel

    Interesting, but a bit drier than I wanted it to be. I do find the intersection of public policy and epidemics a rich area to consider (especially since they're both complicated by class and race), but the subject is too dense and it gets hard to see the human motivations behind press clippings and the minutes of council hearings. Interesting, but a bit drier than I wanted it to be. I do find the intersection of public policy and epidemics a rich area to consider (especially since they're both complicated by class and race), but the subject is too dense and it gets hard to see the human motivations behind press clippings and the minutes of council hearings.

  15. 4 out of 5

    Matt

    Those of us living in the era of COVID-19 who are experiencing a challenge none of us have experienced in our lifetimes are understandably drawn to histories of other pandemics. The most common parallel is probably the 1918 Spanish flu. I turned for my reading instead to this history of smallpox more out of convenience than anything – I had read much of it several years ago, and the book still sat on my shelf. I was originally drawn to the topic because smallpox is really the granddaddy of infec Those of us living in the era of COVID-19 who are experiencing a challenge none of us have experienced in our lifetimes are understandably drawn to histories of other pandemics. The most common parallel is probably the 1918 Spanish flu. I turned for my reading instead to this history of smallpox more out of convenience than anything – I had read much of it several years ago, and the book still sat on my shelf. I was originally drawn to the topic because smallpox is really the granddaddy of infectious diseases. It’s possibly changed human history as much as any other disease, and thanks to Jenner, the field of immunology really started with smallpox. But while other aspects of variola make it very different from COVID, its history still offers the modern reader much more perspective than one might otherwise imagine. And this history is actually a lot narrower than I realized when I bought the book. The subtitle of the book, “An American History,” is a bit misleading; it only covers a brief time period, more or less the Progressive Era. It barely acknowledges the role smallpox played in the decimation of Native American populations. It doesn’t cover the mid-century eradication efforts. But what it lacks in temporal breadth it more than makes up for in depth of social and legal insight. This is the story of a largely forgotten American smallpox epidemic that killed relatively few people but left a surprisingly deep impression on society, government, and the law. The book has a lot to say about race and class, social standing and culture in the United States. It demonstrates well the roots of anti-vaccination sentiment. It focuses on the evolution and development of public health in this country. And it helps explain the limits of federal control when it comes to handling public health crises. In essence, the failures of smallpox control in that time were much more a product of social dissent and political failure than a scientific failure. Anyone who may be frustrated by our societal inability to exact a coordinated response to a global epidemic will easily see those parallels in these pages, despite the obvious situational and temporal differences from COVID. One thing I was unprepared for was the degree to which I would sympathize with the anti-vaccinationists of the era. Our modern understanding of vaccination holds that the practice is very safe and painless, and that’s largely true today because of 20th Century advancements. [I loved this line about anti-vaccinationists: As the Birmingham, Alabama-based Southern Medical Journal lamented in 1921, ‘All the fools are not dead yet.’] But in those days, vaccination was unregulated and even safe smallpox vaccination left a painful inflammation. In one instance, more than 5000 Confederate soldiers were vaccinated from the arm of a soldier who had syphilis. A dozen kids in Camden, New Jersey, were killed from vaccine tainted with tetanus. And people who regularly had reason to fear the government – African Americans and immigrants – were especially reticent to comply with government action during an outbreak. If you were a black citizen at the turn of the last century, would you trust a white doctor, or worse, a white public health official? If the smallpox epidemics at the end of the century had shown anything, it was that democratic institutions and the political communities they governed often moved slowly, especially when official claims to expertise and visions of social control collided with the interests, beliefs, and values of the people. One aspect of smallpox I had been completely unaware of before I’d read this book was the ‘mild form’ of the disease, variola minor, which killed less than 1% of those infected. It was especially difficult to get the public to comply with vaccination efforts when the outbreak involved the much less virulent form of the disease. From a public health perspective, though, the most dangerous thing about mild type smallpox was that it did not lay people low enough. Some people recovered without ever taking to their beds. … Contagious men and women worked in the fields and factories, ran grocery stores, and mingled in the crowd on court day. In those cases, a person wouldn’t have to be deeply distrustful of government or be an avowed libertarian to want to avoid vaccination. Again, I wouldn’t aim to draw too close the parallels between the fight to contain smallpox circa 1900 versus the efforts to contain COVID in 2020. Obviously, no viable vaccine exists as the recent epidemic is wreaking havoc. But in many ways, public health officials are fighting the same battles. In both periods of history, people want to scapegoat foreign influences, outsiders and marginal figures. In both periods, constitutional principles are put to the test. Uncompromising individualism is pitted against social intervention. Social cleavages and inequalities are laid bare. Risk to public health and freedom of movement are challenged. Of course, if it’s 100 years in the past, it makes for great academic fodder and great drama. If it’s happening more immediately, it’s just a punch to the gut.

  16. 4 out of 5

    Lynne

    It was interesting to read about the debate between the doctors and the "anti-vaccinators" in the context of a hundred years ago and how it parelells the current discussion. It was interesting to read about the debate between the doctors and the "anti-vaccinators" in the context of a hundred years ago and how it parelells the current discussion.

  17. 4 out of 5

    Erich

    “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 e “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” Okay that’s a little on the nose Justice Harlan.

  18. 4 out of 5

    Scott J Pearson

    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 S 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.

  19. 4 out of 5

    Hunter James

    "Using the flawed late nineteenth-century census returns to bolster their case, white experts claimed that the health of African Americans had plummeted since emancipation. This proved, the authorities claimed, that blacks had benefited from slavery and were so ill suited to freedom that they were now destined for extinction." "Frequent bouts with naysayers led some officers to wish, in published government health reports, for the appearance of a "fool-killer": a fatal case of smallpox. As one No "Using the flawed late nineteenth-century census returns to bolster their case, white experts claimed that the health of African Americans had plummeted since emancipation. This proved, the authorities claimed, that blacks had benefited from slavery and were so ill suited to freedom that they were now destined for extinction." "Frequent bouts with naysayers led some officers to wish, in published government health reports, for the appearance of a "fool-killer": a fatal case of smallpox. As one North Carolina official put it, the best cure for a doubting public was "a good first-class case of small-pox." "...many citizens saw no reason to elevate the medical opinion of a health official above their own." "Communities of cotton mill workers, who notwithstanding their claims to white privilege were among the most exploited and marginalized southern laboring people, were deeply distrustful of medical authority." "But the essence of the plan was to mobilize African Americans at the grassroots to fight a deadly infectious disease." "Before setting sail, Balmis inoculated the first child with vaccine; as the expedition made its way across the seas, the doctor kept the "precious fluid" alive by vaccinating each child in succession, with pus from the vaccine sore of the previous child, in a continuous arm-to-arm relay." "...the board refrained from endorsing any make of vaccine and offered no advice as to how anyone might distinguish the "trustworthy" from the more dubious products on the market. Trust was a commercial transaction, not a public dispensation." "The vaccine crisis seemed to require a new role for the state in controlling production... The disasters in St. Louis and Camden convinced many physicians and health officials that vaccine production had been left to the free market for too long. "The lesson we have principally to learn from these catastrophes," said Dr. Dalton of New York, "is the necessity of eliminating commercialism from matters pertaining to public health." "Vaccination should be the seal on the passport of entrance to public schools, to the voters' tooth, to the box of the juryman, and to every position of duty, privilege, profit or honor in the gift of either the State or the Nation." "As health officials and police tightened enforcement of vaccination at public schools, industrial work sites, and railroad depots, Americans started forging scars... "Get a little strong nitric acid," advised the Colombus, Ohio-based journal Medical Talk for the Home. "Take a match or a toothpick, dip it into the acid, so that a drop of the acid clings to the end of the match. Carefully transfer the drop to the spot on the arm where you with the sore to appear. Let the drop stand a few minutes on the flesh. Watch it closely." After a few minutes, the skin, stinging, turned red..."This sore will gradually heal by producing a scar so nearly resembling vaccination that the average physician cannot tell the difference." Health officials condemned the "vile crime" as the handiwork of a few antivaccination fanatics. But these intimate acts of civil disobedience were part of something larger, a groundswell of popular opposition to "state medicine." "The presence of smallpox in any community endangers business as well as life," said the times." "It may sound absurd to contemporary ears, but antivaccinationists were in fact more conscious than were most progressives of the coercive potential of the new interventionist state. In a few short years, American eugenicists would be persuading state legislatures to enact compulsory sterilization laws for the "feeble-minded" epileptics, and other people deemed "unfit" to reproduce. The eugenicists' chief legal precedent for their measures would be compulsory vaccination."

  20. 4 out of 5

    Liz Barr

    Pox: an American History is less about smallpox in general, and more about the epidemics that swept America at the turn of the century, and how they led to the formation of a federal health system, plus debates about compulsory vaccination, medical ethics and more. Now, smallpox was one of my big childhood fears (along with black holes and Daleks), so I started this book thinking that anyone who refused a smallpox vaccine was a dangerous idiot, same as the contemporary anti-vaxxers. But it’s actu Pox: an American History is less about smallpox in general, and more about the epidemics that swept America at the turn of the century, and how they led to the formation of a federal health system, plus debates about compulsory vaccination, medical ethics and more. Now, smallpox was one of my big childhood fears (along with black holes and Daleks), so I started this book thinking that anyone who refused a smallpox vaccine was a dangerous idiot, same as the contemporary anti-vaxxers. But it’s actually a lot more complicated than that: the smallpox vaccine was (and still is!) the most dangerous, side-effect-filled one around, and for many people, the vaccine was worse than the disease. Even if you didn’t get tetanus from an infected sample, as many children did, you might be unable to work for weeks until your body recovered. For poor people with families to support, that was an unacceptable choice. Oh yeah, and many states and cities had compulsory vaccination before there was a safe vaccine. Then there’s the issue where, yeah, smallpox was basically wiped out in the Philippines, but that was because the US army were rounding people up and vaccinating them by force. In the United States, the same treatment was meted out to African Americans and Italians, and anyone else who seemed a bit shifty. (Spoilers! Wealthy white people were treated differently to the poor! I know, who saw that coming, right?) In fact, for quite a few years, white Americans, particularly in the South, were quite convinced that smallpox was restricted to black people. Boy, were they hilariously wrong. There’s quite an interesting sequence about a public health official, whose name now escapes me and my Kobo is not to hand, who basically made it his mission to promote public health in the South. And he came to the conclusion that Southerners were intelligent, sensible people who would give you a chance if you were honest with them, but their political institutions were messed up. That seems pretty universal, really. (This guy was also the son of a Confederate hero, a very privileged white dude who was quite pro the Jim Crow laws and other general racism, but he was also one of the few public health officials who even acknowledged that African Americans also needed support in their health issues, and he spent his later years empowering black communities to wipe out tuberculosis. People: complicated.) Suffice to say, things were pretty complicated and a lot of people died before matters were taken in hand. Willrich had a lot to say about the growing power of the federal government at the time, much of which I skimmed because it was quite repetitive. One of those books where the topic is more interesting than the writing. But it basically boiled down to this: The federal government finally began to oversee vaccine manufacturing, and imposed restrictions and rules, and shut down any manufacturers who weren’t doing their job properly. This was hailed as the rise of socialism and the end of American democracy. So far, so contemporary. But what we don’t get these days is actual socialists taking offence and saying, nope, this is all so much capitalist bullshit, and a pox (heh) on both your houses.

  21. 4 out of 5

    ManOfLaBook.com

    "Pox: An American History" by Michael Willrich is a non-fiction book which traces how the smallpox vaccine was distributed during major outbreaks. Some of the vaccines were forced onto people which caused an outrage and the question made it all the way to the Supreme Court. The book clearly suggests that an overlooked legacy of American dissent was the antivaccinationists. An increasingly powerful government took on the progressive position that the benefit of all people outweighs the problems of "Pox: An American History" by Michael Willrich is a non-fiction book which traces how the smallpox vaccine was distributed during major outbreaks. Some of the vaccines were forced onto people which caused an outrage and the question made it all the way to the Supreme Court. The book clearly suggests that an overlooked legacy of American dissent was the antivaccinationists. An increasingly powerful government took on the progressive position that the benefit of all people outweighs the problems of the few and started mandatory vaccination campaigns. An interesting and informative part of American history. To my great surprise, "Pox: An American History" by Michael Willrich is an extremely readable and fast paced book. What I mean by “readable” is that the book does not simply recite facts, figures, laws, high level agenda etc. Yes, it does that as well but by telling stories of individuals on both sides of the debate, such as C.P. Wertenbaker, a federal surgeon who worked tirelessly to combat the deadly and preventable disease. On the other side there is Swedish Lutheran minister Henning Jacobson who took his battle to the Supreme Court battling against vaccination. Those stories, big and small, in context with the overall picture are what make the book a joy to read. Mr. Willrich goes beyond just reciting facts and figures; he also frames the debate around vaccinations. At a time when people believed that vaccinations are some sort of a vast government conspiracy (in a way it was), a cabal of the feds with the drug manufacturers – sounds familiar? The questions which were debated and to some extent still are to this day. What rights can or should the federal government ignore in order to protect us? What is the price we are willing to pay? What happens when the interests of the public at large collide with religion/personal conscience? The accounts detailed in the book are very interesting and I learned a lot from reading them. The research is meticulous but the elegant writing makes the book a joy to read, not only if you are interested in medicine, but also for those interested in history and especially the social classes in the United States. Please visit my bookish blog at http://www.ManOfLaBook.com

  22. 5 out of 5

    Paul Pessolano

    “POX” by Michael Willrich, published by The Penguin Press. Category – Medical History How many of us today can roll up our sleeve and show a smallpox vaccination scar? Michael Willrich traces the smallpox epidemic and the fight over vaccination in his book, “POX.” It is hard for us today to disease that for the most part has been eradicated. It is also hard for us to grasp how terrible and lethal the disease was. When it was decided that mandatory vaccination would be necessary to control smallpox, “POX” by Michael Willrich, published by The Penguin Press. Category – Medical History How many of us today can roll up our sleeve and show a smallpox vaccination scar? Michael Willrich traces the smallpox epidemic and the fight over vaccination in his book, “POX.” It is hard for us today to disease that for the most part has been eradicated. It is also hard for us to grasp how terrible and lethal the disease was. When it was decided that mandatory vaccination would be necessary to control smallpox, it was met with great opposition. It was not unusual for Doctors and police to mount a midnight raid on a housing project and forcibly vaccinate the people living there. Many families would lock themselves in their homes, hide under beds or in closets, and some once vaccinated would rub off the vaccination. Even though vaccination was proven to be effective in most cases, a large number of people were apprehensive due to the number of people that suffered injury and death due to vaccination. Most problems were the result of the manufacturers selling tainted medicine because the pharmaceutical industry was not regulated. An even more controversial aspect of vaccination was whether the government had a right to impose a mandatory requirement for vaccination. This led to a civil liberties battle that has repercussions to this day. This book will be of major interest to those who enjoy history and especially medical history. The final 50 plus pages will be of interest to anyone interested in law as Willrich goes through the court cases and rulings that came out of the fight for what people believed to be their right to refuse vaccination. The fight continues today as there are still antivaccinationists groups that still are fighting against any form of mandatory vaccination.

  23. 4 out of 5

    Mauri

    Probably the most important point I took from this is that the anti-vaccination movement is not as new as it seems. It makes sense that people would object to being jabbed with pointy objects, I was just surprised to learn that when faced with a choice of 'sore arm' or 'SMALLPOX', many people still decided to take their chances with the pox. But Willrich lays out the reasons why the "unwashed masses" (ah, the 19th-20th centuries, so full of benevolent ideas about those less fortunate than you) a Probably the most important point I took from this is that the anti-vaccination movement is not as new as it seems. It makes sense that people would object to being jabbed with pointy objects, I was just surprised to learn that when faced with a choice of 'sore arm' or 'SMALLPOX', many people still decided to take their chances with the pox. But Willrich lays out the reasons why the "unwashed masses" (ah, the 19th-20th centuries, so full of benevolent ideas about those less fortunate than you) and might have a point in an era when 1) an unusually mild version of smallpox was sweeping the nation and 2) your 'sore' arm could cause you to miss several weeks of work and probably lose the job that was keeping your family afloat. Plus bonus chance of tetanus or the damned thing not working at all because nobody understood how to properly preserve the vaccine. Then and now, I still don't understand 1) why people don't ask for safer/better vaccines, rather than no vaccines and 2) why people insist that they should have the same rights/privileges as everyone without taking on the same responsibilities/risks. Also, I need to do some reading up on the Spanish-American war, since my knowledge begins and ends with 'Remember the Maine!' Minor point of annoyance - the book was called Pox: An American History and really only covers the smallpox epidemics around 1900 and then only in the context of resistance to vaccination. 3 stars - I am grateful for the knowledge I have received but this was a slog at times and I won't be rereading it.

  24. 4 out of 5

    Denae

    I first heard of Pox: An American History from an interview Michael Willrich did on NPR. It sounded like it could be interesting, and I was not disappointed. Overall, the book only gets 3 stars from me because of some writing style issues and a certain degree of repetitiveness. The fascination of the story, however, kept it interesting. The tying together of the anti-vaccination movement and the idea of enforcing public health measures for the protection of the greater public with the civil righ I first heard of Pox: An American History from an interview Michael Willrich did on NPR. It sounded like it could be interesting, and I was not disappointed. Overall, the book only gets 3 stars from me because of some writing style issues and a certain degree of repetitiveness. The fascination of the story, however, kept it interesting. The tying together of the anti-vaccination movement and the idea of enforcing public health measures for the protection of the greater public with the civil rights movement which followed was well done and an area of history which was entirely new to me. The way the present day's current vaccine "controversy" and the danger in which people are placed because of ignorance and those who deceive the ignorant is chilling, but was in no way overblown. Then there is the topic itself, and the fact that smallpox, once one of the greatest killers of our species has been eradicated is in itself a subject of fascination and a testament to what technology has been able to do. By contrast, there were many people infected by unsanitary vaccines, which presents a stark picture of the origins of today's pharmaceutical industry. Overall, this book interested me, but I think its audience will remain small.

  25. 5 out of 5

    Dee

    Densely written and thorough, traces history of compulsory vaccination against one of mankind's deadliest enemies. More of a social and legal history than a medical one and a bit of a slog due to the immense amount of detail. Sometimes I had a hard time keeping track of all the people, places, local statutes and cases. But Willrich does a good job reminding us of class divides in public health and individual liberties -- in case anyone needs that reminder. Ultimately the book tries to answer the Densely written and thorough, traces history of compulsory vaccination against one of mankind's deadliest enemies. More of a social and legal history than a medical one and a bit of a slog due to the immense amount of detail. Sometimes I had a hard time keeping track of all the people, places, local statutes and cases. But Willrich does a good job reminding us of class divides in public health and individual liberties -- in case anyone needs that reminder. Ultimately the book tries to answer the question: how far should the state go to protect the public welfare -- and who gets to define that concept? Good read.

  26. 4 out of 5

    Laura

    Fascinating account of the smallpox epidemic of 1898-1903 and the social and political history leading up to it. The author did an amazing job of discussing the origins of public health in the US (which basically started with smallpox vaccination), the conflict between personal rights and collective good, the development of consumer safety measures, the effects of immigration and treatment of oppressed groups, and the antivaccination movement of the 20th century. The writing was good and swept t Fascinating account of the smallpox epidemic of 1898-1903 and the social and political history leading up to it. The author did an amazing job of discussing the origins of public health in the US (which basically started with smallpox vaccination), the conflict between personal rights and collective good, the development of consumer safety measures, the effects of immigration and treatment of oppressed groups, and the antivaccination movement of the 20th century. The writing was good and swept the reader along in the drama, but perhaps included more detail than was necessary.

  27. 4 out of 5

    Barbaracase

    Fascinating portrait of the collective American psyche which often values the rhetoric of individual liberty over the public good and corresponding needed social legislation. The author used the history of the development of small pox vaccine and subsequent legal and political rights over mandatory vaccination to tell the story of the struggle between government, business, and individuals. Fascinating even if a tad too detailed. Just skip the names of every local health board member. Brief secti Fascinating portrait of the collective American psyche which often values the rhetoric of individual liberty over the public good and corresponding needed social legislation. The author used the history of the development of small pox vaccine and subsequent legal and political rights over mandatory vaccination to tell the story of the struggle between government, business, and individuals. Fascinating even if a tad too detailed. Just skip the names of every local health board member. Brief section includes story of how the Barnes of The Barnes in Philadelphia made his fortune.

  28. 5 out of 5

    Mary Alice

    Really fascinating. Covers the years 1898 through 1903 in America. The story of the last major small pox epidemic is the story of a civil liberties nightmare in the US and her colonies, the Phillipines and Puerto Rico. The smallpox vaccine is the most dangerous of all the vaccines, and citizens of the world were coerced into receiving the vaccination for the good of the larger community. It actually made me sympathize with some of today's "anti vaccinationists". Really fascinating. Covers the years 1898 through 1903 in America. The story of the last major small pox epidemic is the story of a civil liberties nightmare in the US and her colonies, the Phillipines and Puerto Rico. The smallpox vaccine is the most dangerous of all the vaccines, and citizens of the world were coerced into receiving the vaccination for the good of the larger community. It actually made me sympathize with some of today's "anti vaccinationists".

  29. 4 out of 5

    Lisa

    Fantastic history of state and federal laws as they affect social well being and individual liberties. Science, history, law, politics, racism, xenophobia, conspiracy theories all rolled up into an interesting tale that remains pertinent today although it is about smallpox vaccination laws dating to the turn of the last century.

  30. 5 out of 5

    Becky

    Interesting book, although a bit densely detailed at times, especially in the coverage of lawsuits related to compulsory vaccination. It's hard to believe that smallpox epidemics were common as recently as the early 20th century and that the disease killed one third of those infected. The people who survived were horribly scarred. This is a fascinating history. Interesting book, although a bit densely detailed at times, especially in the coverage of lawsuits related to compulsory vaccination. It's hard to believe that smallpox epidemics were common as recently as the early 20th century and that the disease killed one third of those infected. The people who survived were horribly scarred. This is a fascinating history.

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