The Healthiest City: Milwaukee and the Politics of Health Reform

CHAPTER THREE- The Politics of Health Reform: Smallpox

CHAPTER THREE The Politics of Health Reform: Smallpox Health Commissioner Walter Kempster took time from his efforts combatting a raging smallpox epidemic in Milwaukee in 1894 to reflect on the public's fearful reactions to this disease. "[T]he alarm caused by a few cases of smallpox ," he noticed, "has served to unbalance the equanimity of the entire community." Kempster realized that smallpox, the nineteenth-century "scourge" of Milwaukee, disrupted daily life more than any other disease. Smallpox was physically repulsive, highly infectious, and often fatal. But Milwaukee 's smallpox terror emanated more from fear of the unfamiliar than from the physical dangers of the disease. Kempster continued: "[W]here smallpox claims one victim, diphtheria claims its hundreds; still, about the one disease the community becomes frenzied with fear, while about the other little or no attention is given it."l Milwaukeeans accepted as unavoidable the ravages of the familiar diphtheria , as they did tuberculosis, scarlet fever, and typhoid fever, and developed ways of coping with these killers. They found it more difficult to adjust to a disease that struck the city only occasionally.2 I MHD, Annual Report, 1895, p. 20. 2 Cholera would have produced the same fears, but after the 1849-1853 pandemic that dread disease did not visit Milwaukee. Yellow fever and cholera produced similar reactions in cities unfamiliar with them. Charles Rosenberg, studyinl{ the effects of cholera epidemics on American cities, 76 Copyrighted Material HEALTH REFORM: SMALLPOX Medical disagreements about smallpox prevention and treatment compounded the public's discomfort. Some physicians advocated vaccination as a sure protection against smallpox; others proclaimed vaccination more dangerous than the disease it sought to prevent.3 Some physicians believed that smallpox victims should be treated in an isonoted : "the cholera epidemics of the nineteenth century provided much of the impetus needed to overcome centuries of governmental inertia and indifference in regard to problems of public health.... It is not surprising that the growing public health movement found in cholera an effective ally." The Cholera Years: The United States in 1832,1849, and 1866 (Chicago: Univ. of Chicago Press, 1962), pp. 2-3. See also John Duffy, who posits that cholera and yellow fever were "important factors in promoting public health measures," because of their "crisis" presentation. "Social Impact of Disease in the Late Nineteenth Century," Bulletin of the New York Academy of Medicine, 47 (1971): 800. Although Duffy saw smallpox running a poor third to cholera and yellow fever, in Milwaukee smallpox took the place of the former two diseases, which did not threaten the city after 1850. I make the parallel with cholera and yellow fever despite the major differences between those diseases and smallpox, the availability of a preventive for one and not for the others. While vaccination raises interesting differences between the examples used here, those differences did not affect the public reaction evoked in each case: fear and panic and an immediate governmental response to alleviate conditions. Typically, mortality rates in the late-nineteenth-century smallpox epidemics stayed under 30 percent, although they could have been as high as 50 percent. See M. V. Ball, "Deathrate from Smallpox in Various Cities and States," American Medicine 5 (1903): 450. 3 See Martin Kaufman, "The American Anti-vaccinationists and Their Arguments," Bulletin ofthe History ofMedicine 41 (1967): 463-478. Kaufman describes most anti-vaccinationists as irregular practitioners and identifies the movement with sectarian medicine. It is clear to me that the division does not hold in Milwaukee, where many regularly trained physicians were hesitant about the protective value of vaccination and where many sectarians supported vaccination. Also, the distinction between regular and irregular physicians was a foggy one in the minds of most people who sought medical advice and therefore it is not particularly useful for understanding the acceptance of anti-vaccinationist thought in nineteenth -century American cities. See also Elizabeth Barnaby Keeney, Susan Eyrich Lederer, and Edmond P. Minihan, "Sectarians and Scientists: Alternatives to Orthodox Medicine," in Ronald L. Numbers and Judith Walzer Leavitt, eds., Wisconsin Medicine: Historical Essays (Madison: University of Wisconsin Press, 1981). 77 Copyrighted Material HEALTH REFORM: SMALLPOX lation hospital; others thought home treatment most beneficial . Political and ethnic divisions in the city often exacerbated the medical confusions as coalitions formed around the conflicting ideologies. Typically, the health department used the lack of consensus in the city to step in and increase its authority to control infectious diseases. During only one...