• Pox: An American History
• Michael Willrich
• Penguin Press (2011)

Out of a long-forgotten smallpox outbreak in the U.S. from 1898 to 1903, Michael Willrich has written a combined medical thriller and courthouse drama. Pox: An American History shows us how that outbreak changed American law and politics -- and how little has changed in America since then. A Canadian reader finds important lessons to apply here.

Willrich portrays 1890s America vividly as a nation with grotesque extremes between rich and poor, education and ignorance. This was the Progressive Era, when the elite saw themselves as able (and obliged) to improve the lives of the poor. Science, they believed, had shown the way to rehabilitating criminals, improving housing and working conditions, and especially improving public health.

But 1890s America lacked the institutions to do so. Public health agencies barely existed. The federal government considered epidemics a state and municipal concern. The affluent classes saw diseases like smallpox as ailments of the poor, who had only themselves to blame for their poverty.

But in a world of increasing international trade, travel and migration, America's Progressives knew that the rich couldn't seal themselves off. What's more, they knew that medical technology -- especially vaccination -- could smother a disease like smallpox.

But as Willrich shows, not everyone shared the Progressives' views. Vaccination in one form or another had been used for a century. Doctors didn't really understand smallpox, but they knew that vaccination could protect against it. And they also knew that it could sometimes have catastrophic results.

During the U.S. Civil War, for example, some 5,000 Confederate troops had been vaccinated with materials from a single soldier -- who also happened to have syphilis. Unreliably produced vaccines failed to "take." Even when it worked, vaccination often produced fever and a sore arm, side effects that could cost a worker many days' pay.

Smallpox? Let's take a vote!

Moreover, smallpox had largely faded out after the Civil War, and vaccination wasn't often used. When a "mild" strain appeared in the South in the 1890s and began working its way north, most doctors didn't even recognize it as smallpox. When health officials wanted to vaccinate one community after two cases were identified, the crowd in a courthouse voted in favour of denying the outbreak was smallpox.

Besides, the outbreak was mostly affecting blacks, and white physicians had little interest in caring for them. Blacks, in turn, had learned to fear such doctors and their hospitals. Whites might have agreed with Booker T. Washington's warning that "You can't have smallpox in the Negro's home and nowhere else," but they were not about to deal respectfully with that home's inhabitants.

This was a profoundly racist society -- one that kept non-whites in crowded, filthy tenements and work camps, and then argued that their filth proved their inferiority.

The same attitude prevailed about the immigrants then pouring into New York, especially those from southern Italy who spoke no English and had no idea what the fuss was about. When American officials barged into their tenements to vaccinate their children, riots broke out.

Vaccinating the conquered

As smallpox migrated north, the U.S. was launching its first overseas imperial adventure, the Spanish-American War and the acquisition of new colonies. The U.S. military vaccinated as many of its troops as possible, but not all. To keep their troops healthy in the Philippines, Cuba and Puerto Rico, the military authorities vaccinated every possible native, violently if need be.

It was brutal, but it worked. Heavy-handed as the Progressives were, they had fought the first battles that would end in the destruction of smallpox altogether. The end had justified the means; the Progressives learned that science-based benevolence could be delivered at the end of a bayonet, if need be.