“Permitted to Die of the Small-Pox”

Last weekend the Boston Globe’s Ideas section ran an article by historian Andrew M. Wehrman headlined “A Pox on You.” It starts like this:

On a blustery January night in 1774, scarcely a month after the famous Tea Party in Boston, an even more shocking protest unfolded on Massachusetts’ North Shore. In the dead of night, a crew of 20 men blackened their faces and armed themselves with torches and buckets of tar. The object of their anger was not a chest of tea, a tax collector, or British soldiers. What these men, mostly sailors from Marblehead, burned down was the town’s brand new hospital.

On the surface, such an attack might seem inhuman, or at best ignorant. But the act was the calculated result of long-simmering anger over the cost and politics of smallpox inoculations in one of the largest and most prosperous towns in the Colonies. Their anger would be familiar to anyone today who has faced ballooning insurance premiums, or who was moved to stand up and shout at this summer’s town hall debates on health care.

Wehrman’s study of the destruction of the Marblehead smallpox hospital appeared this year in the New England Quarterly. In this opinion essay, and in a follow-up discussion on N.P.R.’s Talk of the Nation, he touches on larger questions of public health and public resources, which have concerned governments in America from the start.

Later in the week I stumbled across a pertinent item from the Columbian Centinel for 14 Nov 1804. It was a column that combined simple death notices, longer obituaries, and some bills of mortality—early public health information. Among those last items was:

In New-York, from the 26th Oct. to the 3d Nov. 42 deaths;—of whom 14 were men, 10 women, 13 boys, and 6 girls;—by taking laudanum, (suicide) 1 person; TEN of SMALL-POX!—Shame!

Among those who were permitted to die of the small-pox, was Mr. Charles B. Rich, printer, of Brookfield, (Massa.); a young man of strict integrity and emulative worth, and bid fair to be a public, as he had been a private, ornament to society.

The Centinel employees might have felt special regret for Rich’s death because he was a fellow printer, perhaps even one they knew. But they also regretted it because people had started to see smallpox as a preventable disease.

For decades people had realized that an infection with a mild form of smallpox could grant lifelong immunity, lowering the rate of the disease’s transmission and mortality. And in 1798 Dr. Edward Jenner of Gloucestershire (shown above, courtesy of the New York City Department of Health) started to publicize his success at vaccination: injecting people with the rarely fatal cowpox or “kinepox” virus made them immune to smallpox as well.

The Centinel printers felt that having citizens die when people knew of better medical and public-health methods was a stain on American society. And a drain—a healthier public would benefit the nation. That thinking seems to be neglected in the U.S. of A.’s current debate over medical insurance, in which people have paid a great deal of attention to how much different plans might cost without noting how much money each is projected to save based on a healthier population and more efficient use of medical services. (And of course the policy-makers’ debate basically ignores how much more the nation could save by reducing private bureaucracies.)