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  • Pox: An American History
  • Elizabeth A. Fenn
Michael Willrich. Pox: An American History. New York: Penguin, 2011. 422 pp. Ill. $27.95 (978-1-59420-286-5).

In February 2003, I bared my left arm to smallpox immunization in a clinical trial at Duke University. The trial’s purpose was to ascertain the viability of diluted vaccine should smallpox—eradicated in 1980—reemerge as a threat. The physician in charge jabbed my arm repeatedly, in a circular area, with a bifurcated needle—a tiny sharpened fork—amply doused in vaccinia, the cowpox-related virus that confers immunity to smallpox. He then bandaged my wound, gave me a thermometer, and discharged me with instructions to monitor my temperature and stay out of the swimming pool.

Over the next eight days, my lymph nodes swelled, I spiked a fever, and I developed an ugly, oozy pustule the size of a dime. The wound took several weeks to heal: not pleasant, but still good news. My vaccination—a 1:5 dilution—“took.” The symptoms I experienced were normal. But they stand out by comparison to the vaccines that most people are familiar with in the twenty-first century. And they suggest why people have resisted smallpox vaccination both past and present. Even today, vaccinia is known as “the most dangerous vaccine” that we have (p. 342).

Resistance to smallpox vaccination at the turn of the twentieth century is the subject of Michael Willrich’s marvelous book Pox: An American History. The procedure at the turn of the century differed little from the one outlined above.1 But [End Page 663] the experience differed much. In poor neighborhoods, it often took place at the point of a gun or billy club. In some cases, it occurred in the dark of night, as police and public health officers stormed tenements and work camps and ordered occupants to roll up their sleeves. These circumstances alone probably dissuaded many who might otherwise have undergone the procedure—as I did—by volunteering.

Most of those vaccinated endured symptoms like my own and garnered immunity to smallpox for half a dozen years. But some were not so lucky. Some received vaccine bearing not just vaccinia but also contagions like tetanus or syphilis. Others developed insidious forms of vaccinia that could render an arm useless or cause blindness or death. For laborers, a sore arm alone could lead to loss of income and work. These consequences, along with personal and religious objections, led many to question the practice. So too did something else. Smallpox in America after 1898 was caused, for the most part, by a new and milder virus called variola minor—much less deadly than the fearsome variola major of old. Many deemed vaccination more frightening than the new disease.

Willrich shows how circumstances combined to create a storm of opposition at the very moment that smallpox surged across America. Resistance took both individual and coordinated forms, giving birth to a full-fledged antivaccination movement that sprang out of a libertarian wellspring with ties to abolitionism, feminism, and anti-imperialism. “Bodily self-possession,” Willrich observes, was “the sine qua non of human freedom” (p. 253). Legally mandated vaccination was quite literally the insertion of state power into the persons not just of U.S. residents but also of inhabitants of Cuba, Puerto Rico, and the Philippines. At home and abroad, it seemed to some that vaccination and empire came hand in hand, often at the point of a gun. Needless to say, public health officers considered vaccination—in which a few might suffer for the good of the rest—to be part and parcel of the Progressive Era project. They too were right.

I would be remiss not to point out that Willrich’s title is misleading. The book is at once less and more than “an American history” of smallpox. Its chronological sweep is too limited to legitimately claim that mantle. But that is a good thing. For Willrich gives us something more and something better: new takes on imperialism, the birth of big pharma, and the ever-changing intersection of police power, civil liberties, and the public good. These overarching themes emerge from the...


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