Pox (2 page)

The health department's plan was to secure All Nations Block first and then follow the same procedure on the surrounding streets. In the coming days, health officers and police would maintain a quarantine on the block and enforce vaccination in the neighborhood schools. The health department would use all the available methods to fight the disease: total isolation of patients, quarantine of their living environment, vaccination of anyone exposed to the disease, disinfection of closed spaces and personal belongings, and close surveillance of the infected district and its residents.
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It was a sensible protocol, born of medical science and the city's long experience with the deadliest contagious disease the world had ever known. Historically, smallpox killed 25 to 30 percent of all those whom it infected; most survivors were permanently disfigured with the dreaded pitted scars. Decades after the scientific revolution known as the germ theory of disease, biologists and doctors were still searching in their laboratories for the specific pathogen that caused smallpox. But they felt confident they had a strong understanding of the microbe's behavior: its pathological course in the human body, its epidemiological effects in a population, and the immunological power of vaccination to prevent the virus from attacking an individual or proliferating across an entire community. According to the state-of-the-art scientific knowledge, the “infecting germs” of smallpox spread unseen from one nonimmune person to another, communicated in a cough, a brush of bodies, or across the folds and surfaces of everyday things: an article of clothing, a Pullman porter's whisk broom, a piece of mail, a newspaper, a library book, a bit of currency, a shared cigarette. Because smallpox had an incubation period of ten to fourteen days, during which the infected person presented no noticeable symptoms, health officers strived to retrace the circuits of human contact in order to identify probable carriers and contain the outbreak.
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The vaccination corps had not been on the block long before the doctors realized the need for reinforcements, men armed with more than vaccine. As the physicians moved from door to door, rapping loudly and calling for the occupants to come out and be vaccinated, many residents refused to cooperate. The doctors tried to explain the danger, which could not have been easy given the many tongues spoken on the block. But many people would not submit to having their own or their children's arms scraped by the vaccinators without, according to
The New York Times
, “loud wails and even positive resistance.” Receiving word of the worsening situation on All Nations Block, the commander of the West Sixty-eighth Street station dispatched a detail of six policemen to assist the doctors in “enforcing the vaccination.”
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Well into the cool autumn night, All Nations Block echoed with the rapping of nightsticks on doors, the shouting and pleas of the residents within, and, through it all, the rattle of the horse-drawn ambulance wagons as they moved to and from the infected district. By midnight, the vaccination corps had discovered another twenty-two cases on the block, many of them little children, all of them, in the health officers' view, requiring immediate isolation. The ambulance wagons carried the patients five miles over rough city roads to the Willard Parker Hospital, the health department's contagious diseases facility at the foot of East Sixteenth Street on the East River, where the doctors gave them a more full examination. From there they were ferried off Manhattan and many more miles upriver to the city smallpox hospital, the “pesthouse” on North Brother Island, a nineteenacre wooded island situated between Rikers Island and the Bronx mainland. Pesthouses, public hospitals used to isolate poor people suffering from infectious diseases, were the most dreaded of American institutions. The trip to North Brother Island was a grim journey into unknown territory. No known cure for smallpox existed. The pesthouse doctors could do little more than treat the patients' symptoms. It was up to the virus, and to each patient's own resources, to determine who among the infected would die in the seclusion of North Brother Island.

The germ theory taught that contagious diseases such as smallpox did not arise spontaneously; they did not spring to life in vaporous miasmas from stagnant water or decomposing filth, as physicians and sanitarians had previously assumed. Doctors now understood smallpox to be caused by invisible life forms—“germs”—that could only survive and proliferate by infecting human carriers. There seemed to be no animal or insect vector for smallpox: no species of mosquito, rodent, or bird that carried the disease from person to person, place to place. If smallpox suddenly appeared in a previously healthy community, there were only two possible explanations: either viral material from a recent case had survived for a time in clothing or bedding or, more likely, someone had brought the pox into the community. On this point medical science reinforced the common reflex of human communities everywhere to blame sudden misfortune on their most marginal inhabitants, outsiders and “others.”
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“What a potent factor in maintaining the prevalence of small-pox is that unemployed and largely unemployable degenerate, the habitual vagrant or tramp,” observed a writer in the London-based
Lancet
, the preeminent English-language medical journal. “The fact that this parasite upon the charity and good nature of the community is in his turn a vehicle for the spread of other parasites, both animal and vegetable, is common knowledge but practically no compulsory steps have been taken to curtail seriously the vagrant's movements or to promote his elementary cleanliness.”
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Suspicion fell immediately upon one of the infected patients en route to North Brother Island, the black minstrel actor who had just arrived on All Nations Block. A member of the traveling Wright Troupe, the man (whose name is lost to the historical record) had come north only a short time before and had taken a room in one of the houses where the sick children were later discovered. The rumor quickly spread that “this negro” had carried the germs in his body from Pittsburgh and, living in a house filled with playful innocents, infected at least one of them. That child, the theory went, infected classmates in the swimming bath of the Riverside Kindergarten. The theory had an easy plausibility; the white doctors of the health department, no less than the residents of All Nations Block, lived in an American culture of race that scorned black bodies as vessels of moral and physical danger. But perhaps there was more to the theory than a reflexive racism. Smallpox had been epidemic for several years in the American South, where it had spread first and most widely among black laborers in the coal mines, railroad camps, tobacco plantations, and crowded cabin settlements of the rising New South. Given the long incubation period of the disease, it might have been expected that an African American traveler would eventually bring the southern smallpox to New York. On two separate occasions during the preceding three years, smallpox epidemics had struck upstate communities. Each time the New York State Health Department had attributed the outbreaks to a traveling negro minstrel show.
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As the city health department grew concerned about the seemingly connected center of contagion, in the neighborhoods of the West Forties near Eighth Avenue, rumors circulated about a second suspect. He, too, was black. Albert Sanders, twenty-two, had suffered through nearly the full course of smallpox without medical attention before he was discovered; no patient found so far had been infected longer than he was. During this time Sanders had managed to mingle with many people. Unlike the minstrel man, Sanders had been in town for a while, and his name had appeared in the papers before. In the brutal West Side race riot of August 15, 1900, as hundreds of whites taunted and beat blacks in the African American neighborhoods along Eighth Avenue, Sanders had been listed among the injured, suffering from scalp wounds and cuts. Evidently the experience had not inspired in him a trust of whites, doctors included.
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Once two dozen cases of smallpox had turned up on the West Side, the question of the outbreak's precise origin became almost moot. Whoever had started it—the minstrel man of All Nations Block, the unnamed “negress,” Albert Sanders, or someone else—the outbreak would now be difficult to contain.

By December 6, one week after Thanksgiving, the New York papers were calling the outbreak a full-blown smallpox epidemic, the worst in Manhattan since 1892. Three of the patients on North Brother Island had already succumbed to the disease: the servant Mary Holmes; twenty-year-old Elizabeth Oliver; and the Crowley infant, whose mother, it seemed, had not had the heart to name her. The pesthouse now held forty-four smallpox patients, with more arriving almost every day. All hopes of keeping the outbreak quarantined in a small area of the city had vanished when five-year-old Sadie Hemple, until recently a resident of West Sixty-ninth Street and pupil at the Riverside Kindergarten, turned up across the river in Hoboken with a case of smallpox. The virus had incubated in her body while she and her parents moved to their new home, a five-story tenement house where some twenty other children lived. The Hoboken authorities removed Sadie to their own pesthouse, in a place called Snake Hill. New York officials had to concede that the West Side outbreak had “overleaped the bounds” of All Nations Block.
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The health department's vaccination corps was now scraping the arms of the poor at the rate of fifteen hundred per day. Resistance to vaccination had abated in some of the infected areas—where the people were, in the words of one city vaccinator, “well scared up.” More than five hundred poor people called each day for free vaccinations at the board of health's headquarters on West Fifty-sixth Street, most of them mothers with little children in tow. But with each new outbreak in another of the island's crowded tenement districts, the vaccination corps met fresh resistance. Over time, the corps would ever more closely resemble a military outfit. Across the city, private physicians and druggists bought up “hitherto unheard of quantities” of the health department's vaccine stock. At factories, department stores, and offices, employers told their employees to get vaccinated or not bother showing up. On Wall Street, the managers of the New York Stock Exchange set up their own on-site vaccination station. All employees had to submit to the procedure before they could take their positions in the great scrum of the trading floor.
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Among the many political effects of the widening epidemic in New York City was an earnest moral discourse, as the city's chattering classes mulled the significance of the event. The ancient and filthy scourge of smallpox had struck at the very heart—and, it seemed to many, the
very moment
—of modern American civilization.

The New York Times
, the moderately progressive voice of elite opinion, published a series of editorials in which it called the epidemic “a matter of grave public concern.” The editors cautioned their affluent readers against indifference; the outbreak was no longer safely confined to “the congested tenements of one locality.” “Public conveyances and places of public assembly bring all classes together to such an extent that only the recluse can feel quite safe,” the
Times
advised, “and not even the recluse if ministered to by servants who visit friends in the infected districts.”
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Such a recognition of the inescapable interdependence of modern urban life stood as the grand unifying theme of the many disparate progressive reform campaigns of the turn of the century: movements for safer working conditions, social insurance for wage earners and their families, better housing for the poor, new programs to rehabilitate criminals, and innumerable measures to protect the public health. The same ethical and political logic, which held individual liberty subordinate to the collective interests of society, underlay the
Times
's call for universal vaccination: “This is not only a wise measure of personal precaution, but it is a public duty which every citizen owes to those with whom he comes in daily contact.” The
Times
was prepared to take this logic to its furthest conclusion and endorse the most punitive measures for vaccination in the “great and crowded city.” But the editors expected that such measures would prove unnecessary. The “anti-vaccination heresies” that had spread so perniciously in England and other foreign countries in recent years would find few followers in the United States, the
Times
insisted. “Here a saving common sense has prevailed in all classes of the population, and smallpox works serious ravages only in remote corners inhabited by out-and-out savages.” A progressive appeal to social interdependence, civic obligation, and enlightened common sense did not, in this instance, imply tolerance, empathy, or solidarity. Or good taste: three people had recently died in the city, ravaged by smallpox. Were they “savages”?
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These were, of course, the overheated ruminations of editorial writers. The
Times
's editors got the high moral tone of the moment just right, and the facts of the historical events unfolding around them all wrong.

 

 

I
n December 1900, the United States was in the throes of an extraordinary five-year wave of smallpox epidemics. It was the worst visitation of smallpox in a generation or more, and the last Americans would experience on a continental scale, as a national event. From Alabama to Alaska, no state or territory was untouched. Smallpox made its way across an increasingly interconnected American landscape: from southern tobacco plantations to western mining camps to immigrant tenement districts in aging east coast cities; from the nation's capital in Washington to Filipino and Puerto Rican villages on the farthest edges of the new American empire. The epidemics did not confine themselves to a few “remote corners” of the country. Many major American cities experienced deadly epidemics. New Orleans reported nearly 1,500 cases and 450 deaths in 1900. In Philadelphia, smallpox infected 2,500 people and killed nearly 400. Boston recorded 1,600 cases and 270 deaths. And by the time the smallpox epidemic that started on All Nations Block was through with New York City in 1902, the health department had recorded 2,100 cases, and 730 men, women, and children lay dead.
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