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Pox: An American History
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 smallpox epidemic swept the United States from coast to coast. In this gripping account, award- winning historian Michael Willrich chronicles the government's fight against the outbreak and the ensuing clash of modern medicine, civil liberties, and state power. Pox introduces readers to memorable characters on both sides of the debate-from the doctors and club- wielding police charged with enforcing the law to vaccinate every citizen to the anti-vaccinationists, who stood up for their individual freedoms but were often dismissed as misguided cranks. Riveting and thoroughly researched, Pox delivers a masterful examination of progressive-era history that resonates powerfully today.
At the turn of the last century, a smallpox epidemic swept the United States from coast to coast. In this gripping account, award- winning historian Michael Willrich chronicles the government's fight against the outbreak and the ensuing clash of modern medicine, civil liberties, and state power. Pox introduces readers to memorable characters on both sides of the debate-from the doctors and club- wielding police charged with enforcing the law to vaccinate every citizen to the anti-vaccinationists, who stood up for their individual freedoms but were often dismissed as misguided cranks. Riveting and thoroughly researched, Pox delivers a masterful examination of progressive-era history that resonates powerfully today.
345 pages, Kindle Edition
First published March 31, 2011
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Displaying 1 - 30 of 140 reviews
January 9, 2026
Awesome in my opinion! I thoroughly enjoyed this narrative that was part history, study in pathology, study in epidemiology, and legal case study all wrapped in one. Michael Willrich explained and explored the history of smallpox, the different variola variants (chickenpox, cowpox, monkeypox, etc.), focusing this narrative on the 1900 Thanksgiving Day outbreak and its effects through today's modern era.
Willrich explained accounts of the virus' existence from the ancient times and its symptoms found in ancient manuscripts & how it evolved into being among lower-class and being exclusive to certain races. The narrative gave case studies in various geographical locations in the US and outbreaks in wartime in the 18th- and 19th-centuries (Crimea, Spanish-American War, the Mexican-American War).
The last half of the book explained vaccination & inoculation efforts, quarantine during Americam mass immigration in the 1900s, antivaccinationists (religiously motivated in LDS areas of Utah; Church of Science) and the change of political and legal efforts to combat outbreak (in general). Efforts to eradicate polio, measles, and other public health concerns were largely because of earlier efforts to stopping smallpox.
This was a well-written and deserves more credit than it's due. I would highly recommend this as a unique read in public health studies or something different. This is a 2011 pre-COVID publication so that's something to consider. Thanks!
Willrich explained accounts of the virus' existence from the ancient times and its symptoms found in ancient manuscripts & how it evolved into being among lower-class and being exclusive to certain races. The narrative gave case studies in various geographical locations in the US and outbreaks in wartime in the 18th- and 19th-centuries (Crimea, Spanish-American War, the Mexican-American War).
The last half of the book explained vaccination & inoculation efforts, quarantine during Americam mass immigration in the 1900s, antivaccinationists (religiously motivated in LDS areas of Utah; Church of Science) and the change of political and legal efforts to combat outbreak (in general). Efforts to eradicate polio, measles, and other public health concerns were largely because of earlier efforts to stopping smallpox.
This was a well-written and deserves more credit than it's due. I would highly recommend this as a unique read in public health studies or something different. This is a 2011 pre-COVID publication so that's something to consider. Thanks!
January 10, 2012
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.
May 6, 2011
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.
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.
July 11, 2011
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.
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.
February 7, 2012
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
April 12, 2020
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!)
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!)
September 25, 2014
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.
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.
May 9, 2011
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.
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.
June 2, 2015
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.
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.
May 18, 2020
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.
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.
January 18, 2015
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!
January 8, 2015
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.
March 15, 2021
The first half is exceptionally boring. It narrates the epidemic of smallpox throughout the US at the turn of the century. Each chapter goes through the story of the epidemic in a particular location, then circles onto the next place with exact same story, which is terribly repetitive. "And then it struck Virginina, and this happened. And then it hit New York, in this almost identical but slightly different way. And then New Jersey, and that happened there, too." It's technically accurate and well-researched, but as a piece of popular writing, it fails miserably.
The second half focused on anti-vaxxers, which was an improvement. It's interesting that this focuses specifically on the turn-of-the-century smallpox epidemic, because unlike older epidemics, they had a perfectly efficacious vaccine available, but people refused to take it (admittedly, the vaccines had a lot of problems, including tetanus- contaminated vaccines that killed dozens of children-- but significantly less than ultimately ended up dying of smallpox). Obviously, like literally everything related to disease, it's an easy comparison to the current pandemic and modern anti-vax movement.
The second half focused on anti-vaxxers, which was an improvement. It's interesting that this focuses specifically on the turn-of-the-century smallpox epidemic, because unlike older epidemics, they had a perfectly efficacious vaccine available, but people refused to take it (admittedly, the vaccines had a lot of problems, including tetanus- contaminated vaccines that killed dozens of children-- but significantly less than ultimately ended up dying of smallpox). Obviously, like literally everything related to disease, it's an easy comparison to the current pandemic and modern anti-vax movement.
July 8, 2016
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.
January 1, 2013
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.
June 13, 2018
This book gave a lot of texture to the cultures of the times. It also was a very factual depiction of events. As a history buff those parts were interesting but it was a very dry read. It was not very engaging and I really had to work to stick with it. It was more like a book you would be assigned to read for a college course than one you would read for pleasure.
November 13, 2018
More detail than I really wanted, but I found it interesting. I didn't realize how controversial, and dangerous, the smallpox vaccine was. The epilogue, which summed up the public's perception of vaccines in the mid-twentieth century to the present day, was particularly good.
March 28, 2020
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.
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.
December 24, 2011
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.
Want to read
October 19, 2011NPR Here & Now: 19 Oct 2011 - interview w/ author on how he got idea for book
February 14, 2012
Interesting take but writing kinda drags in places - gets caught up in details instead of moving the narrative along.
July 6, 2012
Very interesting topic that will fascinate people ranging from public health professionals to social justice advocates, but the writing is a little dry.
February 9, 2015
Nice overview of public policy as it relates to health and vaccination.
May 12, 2018
Well researched, but the story never grabbed me. I had to force myself through it.
September 21, 2020
“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.
Okay that’s a little on the nose Justice Harlan.
May 12, 2019
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.
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.
January 23, 2022
History repeats itself. In the 1890s smallpox was plaguing the south and further dividing the race in the US. This collections of chapters explores several cities and their response, scenarios, and leaders contributions as the smallpox impacted their communities.
The lesson of these events informed the laws of today. Many of the same bias unfolded similarly in conspiracy theory. We are not getting too much smarter despite 100+ years of accumulated science and experience.
The lesson of these events informed the laws of today. Many of the same bias unfolded similarly in conspiracy theory. We are not getting too much smarter despite 100+ years of accumulated science and experience.
January 10, 2025
Really interesting book about smallpox at the turn of the century in America with prescient questions about vaccine campaigns and the complications that can arise. The imperialism chapter was especially good
September 9, 2016
"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."
"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."
September 29, 2021
It was impossible for me to read ‘Pox’ and not continue to compare it with the public’s present reaction to Covid-19. The book was published in 2011. Mr. Willrich’s descriptions of large segments of our citizenry unwilling to get vaccinated in early 1900s echo today’s reasons. I found it truly discouraging that 120-years later, despite the seriousness of a deadly virus and our major advances in science as well as technology, a subset of humans seem to retain the reasoning and emotional qualities on par with Homer Simpson. ‘Pox’ focuses on the smallpox epidemics raging between 1898 and 1903 in the United States and its newly acquired territories. The nine-page epilogue zips through smallpox’s history up to present day and the challenges in eradicating future threats.
The highly contagious smallpox caused “… raging fevers, headaches, severe back pain, and, likely, vomiting, followed by the distinctive eruption of pocks on their faces and bodies.” Historically, the virus killed 25-30% of all those infected, yet, different strains of the smallpox could only result in as low as 10% of people dying. The little bugger surely didn’t mess around. The advent of variolations and vaccinations made the chances of surviving smallpox much greater. The author gives a clear explanation of how the virus works. There are a handful of black-and-white photos sprinkled throughout the book and I recommend you avoid eating while looking at one specific example. ‘Pox’ covers such topics as pesthouses and the blowback of NIMBYism; the advent of a national public health system; the urban-and-rural divide towards vaccination; how Jim Crow and stereotypes of the poor affected the way smallpox was handled; the U.S. military health forces successfully intervened during the Spanish-American War towards citizens of Puerto Rico, Cuba, and the Philippines; the debates about risk, responsibility and the role of government in managing both; compulsory vaccination; the market for phony vaccination certificates; the disagreements between the American Medical Association and alternative-medicine practitioners; mandatory vaccinations for all immigrants; government coercion versus working-class resistance; and the moral grey areas involving religious and civil liberties. The book also touches upon other virus scourges as typhoid, cholera, malaria, yellow fever, and tuberculosis. Much like today, rumors back then quickly undermined facts. Granted, at the turn of the nineteenth century, the unregulated making of vaccinations in the United States by any entrepreneurial Tom, Dick, or Harry certainly warranted people being skittish but government intervention quickly led to dramatic improvements in the quality of vaccines. Much like our efforts to improve food safety and remove water-borne illnesses that plagued the early nineteenth century, our society today is also vastly safer when it comes to medical practices. The last chapter deals with the legal arguments and decisions concerning mandated vaccinations.
At its core, the story is about the struggle between personal liberty and a deep distrust of government versus social responsibility with government spearheading it. Much like today, vaccine resistance was more prevalent in southern states and rural areas. Violence against mandates and the location of pesthouses were common. The worldwide eradication of smallpox was through a strategy of isolation, surveillance, and targeted vaccination. Force was often used. Mr. Willrich’s ‘Pox’ unintentionally highlights how little has changed in the regionally mindsets of Americans. The book was well-written, informative, and discouraging when I consider how easy it was for Trump and conspiracy pushers to hornswoggle such a sizeable group of Americans.
The highly contagious smallpox caused “… raging fevers, headaches, severe back pain, and, likely, vomiting, followed by the distinctive eruption of pocks on their faces and bodies.” Historically, the virus killed 25-30% of all those infected, yet, different strains of the smallpox could only result in as low as 10% of people dying. The little bugger surely didn’t mess around. The advent of variolations and vaccinations made the chances of surviving smallpox much greater. The author gives a clear explanation of how the virus works. There are a handful of black-and-white photos sprinkled throughout the book and I recommend you avoid eating while looking at one specific example. ‘Pox’ covers such topics as pesthouses and the blowback of NIMBYism; the advent of a national public health system; the urban-and-rural divide towards vaccination; how Jim Crow and stereotypes of the poor affected the way smallpox was handled; the U.S. military health forces successfully intervened during the Spanish-American War towards citizens of Puerto Rico, Cuba, and the Philippines; the debates about risk, responsibility and the role of government in managing both; compulsory vaccination; the market for phony vaccination certificates; the disagreements between the American Medical Association and alternative-medicine practitioners; mandatory vaccinations for all immigrants; government coercion versus working-class resistance; and the moral grey areas involving religious and civil liberties. The book also touches upon other virus scourges as typhoid, cholera, malaria, yellow fever, and tuberculosis. Much like today, rumors back then quickly undermined facts. Granted, at the turn of the nineteenth century, the unregulated making of vaccinations in the United States by any entrepreneurial Tom, Dick, or Harry certainly warranted people being skittish but government intervention quickly led to dramatic improvements in the quality of vaccines. Much like our efforts to improve food safety and remove water-borne illnesses that plagued the early nineteenth century, our society today is also vastly safer when it comes to medical practices. The last chapter deals with the legal arguments and decisions concerning mandated vaccinations.
At its core, the story is about the struggle between personal liberty and a deep distrust of government versus social responsibility with government spearheading it. Much like today, vaccine resistance was more prevalent in southern states and rural areas. Violence against mandates and the location of pesthouses were common. The worldwide eradication of smallpox was through a strategy of isolation, surveillance, and targeted vaccination. Force was often used. Mr. Willrich’s ‘Pox’ unintentionally highlights how little has changed in the regionally mindsets of Americans. The book was well-written, informative, and discouraging when I consider how easy it was for Trump and conspiracy pushers to hornswoggle such a sizeable group of Americans.
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