• Barbara Mathews

Vital Statistics and a Menace to Public Health


The Massachusetts Genealogical Council sent me to Phoenix, Arizona, last summer[2] to attend the national conference of the National Association of Public Health Statistics and Information Systems, an organization involving the vital statistics registrars in the 50 states, cities of Washington, DC, and New York, NY, and five U.S. territories. I was to learn what concerns registrars, what drives them, and what we could do to support the registrar here in Massachusetts. Little did I know that this would lead me to a Supreme Court case, coercive vaccinations, a founder of NEHGS, and the state vital record database.


Only a fraction of the conference attendees were registrars. The majority of attendees were public health statisticians, working for agencies such as the Massachusetts Department of Public Health, similar agencies in other states and in Arizona’s counties, the Indian Health Service, the Veterans Administration hospitals, the U.S. Centers for Disease Control, and civil registration vendors, including Ancestry.com.


In Phoenix, I met Bruce Cohen, from Mass. DPH, who told me that his summer interns had collated cause-of-death information from 1842 to the present. On his return to Boston, he shared the Excel spreadsheet and put me in touch with State Epidemiologist Alfred DeMaria, MD. As a genealogist, my first thrill was to scroll through the information, and look for causes of death I’ve seen in my research.


Smallpox got my attention. It is suspected in the massive number of Native American deaths soon after European settlement in New England. It came back again-and-again. It provides a story that involves Massachusetts in health-care leadership and in a landmark Supreme Court decision.


Smallpox: the Numbers


Historically, Boston suffered at least six major smallpox epidemics prior to 1723, when a mapmaker listed their dates.


Dates of Earliest Smallpox Epidemics in Boston[3]













Smallpox continued to scourge Massachusetts. Lemuel Shattuck (a founder of the New England Historic Genealogy Society) served on a statewide sanitary commission whose report is widely recognized as a beginning of the field of public health. That report produced more statistics on smallpox deaths in Boston.


Year = Smallpox Deaths in Boston

17218 = 50

1730 = 500

1752 = 569

1764 = 170

1776 = 57

1778 = 2243

1792 = 198[4]


Massachusetts began civil registration on a statewide basis in 1841. The DPH statistics show that smallpox ran rampant in the 1870s and 1880s and then nearly ended. Why? And what was it about that last peak, the one in 1902? What happened to end smallpox at that point almost completely?


Deaths in Massachusetts Due to Smallpox, 1842-1934[5]


Smallpox: the Response


In Boston during the 1721 epidemic, Zabdiel Boylston inoculated 247 or 286 (the number is variously reported) people with smallpox; these people had a better survival rate then the untreated. The death rate of the inoculated was 2.4% as compared to the death rate of the 6006 naturally infected people, which was three times higher, at 7.7%.


In 1798, Edward Jenner published his discovery that cowpox inoculations were safer for the patient but just as effective a deterrent to smallpox. Early Massachusetts laws had permitted towns to quarantine patients or to remove them to special hospitals for treatment. With news of this newly introduced and safer inoculation, on 6 March 1809 the Massachusetts legislature passed a law that permitted local town or city authorities to demand mandatory vaccination in response to smallpox epidemics. Antivaccination advocates opposed this. In 1834, the legislature weakened the law. In 1854, the legislature required vaccination for school admission. Finally, in 1877, most likely in response to the worst smallpox outbreak for some time, the state began enforcing the law. The last graph shows that the enforcement of the vaccination law for school entry may have contributed to a lower running rate of smallpox over the next few decades.


Then the 1902 epidemic struck. The City of Boston forcibly inoculated thousands of people, many in immigrant neighborhoods. The newspapers covered the events, noting that force was used on some transients. In one such story, a policeman sat on a man’s legs, another on his head, while his bare arm was pulled out for the doctor to inoculate.


The City of Cambridge mandated forced vaccination for smallpox but the city had a vocal antivaccination group, among them the Rev. Henning Jacobson, a Danish immigrant, Evangelical Lutheran minister, hypnotist, and psychic. He was fined $5[6] and brought suit, only to lose in District Court and in the Massachusetts Supreme Judicial Court. He appealed to the U.S. Supreme Court, which on 20 February 1906 ruled against him, stating that “a community has the right to protect itself against an epidemic.”[7]


The state started producing its own vaccine, ensuring quality and making vaccination free for everyone. With universal vaccination for school-age children, the smallpox rate in Massachusetts plummeted to nearly zero, the last case having occurred in Massachusetts in 1932.


Jacobson v. Massachusetts remains a landmark in the enforcement of public health policy.

Thank you to statistician Bruce Cohen, and epidemiologist Alfred DeMaria, MD, both of Mass. DPH, for their generosity in sharing statistics, background information, and time.

_____________________________________

[1] “About 10,000 Vaccinated In South Boston: Board of Health Had 115 Physicians at Work–It intends to Bring Those Who Refuse Into Court,” Boston Daily Globe, issue of 28 Jan 1902, p. 14; cited in Michael R. Albert, MD, Kristen G. Ostheimer, MA, and Joel G. Bremen, DTPH, “The Last Smallpox Epidemic in Boston and the Vaccination Controversy, 1901-1903,” Occasional Notes, New England Journal of Medicine, 344 (Feb 2001): 378.


[2] In June, just in time to experience record heat, which is a nice memory when the temperature is sub-zero.


[3] Extract from John Bonner, The Town of Boston in New England (Boston: William Price publisher, 1723), Norman B. Leventhal Map Center, Boston Public Library; http://maps.bpl.org/id/11122 : viewed 4 Jan 2014.


[4] Lemuel Shattuck at alia, Report of a General Plan for the Promotion of Public and Personal Health, Devised, Prepared, and Recommended by the Commissioners Appointed under a Resolve of the Legislature of Massachusetts Relating to a Sanitary Survey of the State, Presented April 25, 1860, commonly called the Shattuck Report (Boston: Dutten & Wentworth, State Printers, 1850), 42.


[5] Graph from Alfred DeMaria, MD, “Smallpox in Massachusetts,” slide 28 of 53; statistics from Bruce Cohen, “Historical Vitals 1842-1928,” Excel spreadsheet, Department of Public Health, Massachusetts.


[6] M.G.L. 111 § 181, unchanged since that time:“Boards of health, if in their opinion it is necessary for public health or safety, shall require and enforce the vaccination and revaccination of all the inhabitants of their towns, and shall provide them with the means of free vaccination. Whoever refuses or neglects to comply with such requirement shall forfeit five dollars.” https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111/Section181 : viewed 4 Jan 2014.


[7] Wendy E. Parmet, JD, Richard A. Goodman, MD, JD, MPH, and Amy Farber, MD, “Individual Rights versus the Public’s Health – 100 Years after Jacobson v. Massachusetts,” New England Journal of Medicine, 352 (Feb 2005): 652.


Last modified on Monday, 06 January 2014

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