“a pest-house prepared”
1822 - 1824
January 24, 1824, a stranger was taken suddenly and violently ill at Tyler's Tavern. Dr. Huntington and myself early saw that his case was uncommon and suspicious, and next morning five of the neighboring physicians were summoned, and decided it was small-pox A town meeting was called, a pest-house prepared— being a rough boarded tool-house near the Guard Locks.
The Autobiography of Dr. John O. Green, 1884
Introduction
This third part of this series begins in 1822, when the area was still East Chelmsford, with the arrival of the workers who built the mills and canals and the first doctor who treated them. It ends with a controversy about a smallpox victim who came to East Chelmsford when the town was unprepared for someone with his disease.
Extraordinary changes took place in this area as America evolved from the era of localized industries to one of more large-scale industries supplying much larger areas. The Merrimack Manufacturing Company began construction in 1822 and many workers were brought to the area as the mill produced its first textiles on September 1, 1823.
The moving of people from rural areas to more crowded living and working conditions quickly established a very different public health environment for inhabitants. However, people were moving into these conditions without the supporting infrastructure or a knowledge of the causes of crowd diseases.
The “dark Satanic Mills” of England were surrounded by dark unhealthy neighborhoods that housed the workers and their families. These neighborhoods were in many ways worse than the mills themselves, as the workers’ living conditions did not directly despoil the mills’ products or affect profits.
New England provided a much healthier environment than England at that time, and had more and better resources to sustain a healthy population. However, the rural-to-urban shift created problems that were unknown in the farms and small villages. For example, the people who moved from rural farms to urban factories and boarding houses had no immunity to smallpox because of the lack of exposure to it, and because they would not have had the need or desire to be vaccinated. Other air-borne and water-borne pathogens also found denser population areas far more hospitable than the farms and countryside.
This article will focus on one of the beginnings of the “crowd diseases” and public health challenges that resulted from the movement on large numbers of people into a relatively small area. Crowd diseases are diseases that need a critical mass of centralized human populations to increase and thrive. The problems that developed as people lived and worked closer together had to be understood and addressed without knowing their actual causes. In retrospect, we can identify the germs and see where the viruses and bacteria established themselves in the population and moved from person to person. At the time, people had to put forth their own theories or borrow from prevailing theories of the day.
The public health infrastructure that we take for granted now including filtered and chlorinated water, sewers, HVAC systems, sidewalks, ambulances, trash and garbage collection, refrigeration, bathrooms with sinks and soap, first aid supplies, pharmacies, conveniently available food and drink, and even hand sanitizers, did not exist. There was the general sense that clean is better than filth and that some illnesses were contagious, but specific causes and effective solutions were only guessed at.
John Orne Green (1799 – 1885) was born in Malden, Massachusetts. He was the eldest son of Reverend Aaron Green, a minister in Malden, and Eunice Orne Green. He graduated from Harvard as a member of the class of 1817. After graduation, Green accepted a teaching position in Castine, Maine at a private Latin School for 30 boys.
While in Castine, his choice of a profession was “the subject of chief consideration.” He knew well the clergyman’s life and decided that, although he had great respect for his father the ministers he knew, he would not pursue a career “so laborious and so ill requited.”
The medical profession seemed much more his calling. In his autobiography, he witnessed “several leading men in the medical profession” around him, mentioning Dr. Ephraim Buck, of Malden, Drs. Walker and Thompson of Charlestown, Dr. Gardner of Lynn, and Dr. John Brooks of Medford who was his father's physician and later the 10th Governor of Massachusetts. In his senior year of college he listened “with intense interest” to lectures by Dr. James Jackson, Dr. John C. Warren, Dr. John Gorham, and Dr. Walter Channing, “men not only of the highest professional attainments, but with such refinement of manners and high sense of honor as would make them men of mark in any community.”
Later writing about medicine he stated that
[n]o science has such extensive and intimate connection with other sciences. It gathers to itself the resources of chemistry, botany, mechanics, comparative anatomy and physiology, and mental philosophy, and fills its storehouse of facts with a variety sufficient to satisfy the most eager curiosity.
In September 1818, Green began the study of medicine with Dr. Ephraim Buck, M. D. (1786 – 1859) in his hometown of Malden. He always thought of Dr. Buck a “model country doctor.” Green “shared his rides and prepared his medicines.” After years of, in Green’s words, “this ill paid toil,” Dr. Buck moved to Boston, entering a lucrative practice, and also served as President of the Suffolk District Medical Society.
While the life of a country doctor had some appeal to Green, it seemed that there were still things more and different that he wanted to know and do. In the winters of 1818 and 1819, he walked five miles to Boston with two other students to attend medical lectures on Mason Street, which began at 9:00 in the morning. According to Green, he and his two companions were “among the more punctual and constant of the class.”
In October 1821, Green continued his study of medicine with Edward Reynolds, M.D. (1793 – 1881) in Boston. Dr. Reynolds at that time was the City Physician of Boston, and was in charge of the old almshouse on Leverett Street. Bostonians who could afford it had their own doctors and were treated in their homes. The poor were treated in hospitals and dispensaries. Caring for this population would have given Green a very different view of medicine and disease than he would get either as a country doctor or a city doctor treating patents in their homes.
In 1824, Dr. Reynolds went on to be a co-founder with Dr. John Jefferies of the Boston Eye Infirmary, its mission was to treat the poor and serve as a teaching center. This charitable clinic began treating ear diseases as well and was incorporated in 1827 as the Massachusetts Charitable Eye and Ear Infirmary, today familiarly known as Mass. Eye and Ear.
Later on, Dr. Reynolds later became a member of the first corps of instructors at the Tremont Street Medical School, which later merged with Harvard Medical School. Founded in 1838, the Tremont Street Medical School was located at 33 Tremont Row in Boston, in rooms above Burnett's apothecary store. There was also a private dissecting room in the rear of a savings bank on Tremont Street. Students were offered “a daily attendance Massachusetts General Hospital, and at the Eye and Ear Infirmary, with frequent opportunities of seeing cases, and surgical operations, in private practice, and in the pubic dispensaries. Arrangements have been made for affording obstetric practice to a considerable extent under the superintendence of the instructors.” The other instructors were Jacob Bigelow, D. Humphreys Storer, and Oliver Wendell Holmes.
Dr. Reynolds taught anatomy and surgery including diseases of the eye and ear. Dr. Bigelow taught the theory and practice of medicine, clinical instruction, and Materia Medica. Dr. Storer taught chemistry and midwifery “with practical instruction on the application of obstetrical instruments on the machine or model.” Dr. Holmes taught anatomy with Reynolds, surgical anatomy including demonstrations and dissections, and physiology and pathology “including a special course on Auscultation and Percussion.”
Between November 18 and December 21, 1821, Green wrote his thesis for his medical degree. He was examined on it on February 20, 1822 by the faculty, read and successfully defended his thesis on February 23rd, and received his degree of M.D. on March 10th.
Decades later, in his autobiography, Dr. Green wrote about his first trip to the area that would become Lowell,
While casting about for a place to begin my lifework, Dr. William J. Walker, of Charlestown, through his brother-in-law, Thomas Hurd, who was then a woolen manufacturer here, had heard privately that the Waltham Company were about to erect two mills here, and this would attract, probably, a population of one thousand, and a young man might find by patient waiting, a decent living, and advised me of these facts.
On the twenty-fifth of March 1822, Dr. Buck and myself rose at three o'clock a. m., and drove up to reconnoitre. We were introduced and our business made known to Mr. Boott, Mr. Hurd, Capt. Jonathan Tyler, Capt. Whiting, and some others. The former, in a short interview in the dust and sand, among the diggers, spoke encouragingly of my coming, the other gentlemen intimating cautiously that the profession in their vicinity was abundantly and ably supplied. We dined at Tyler's tavern, and returned to Malden. I was not long in coming to a decision, for here certainly seemed a chance even, in what was then considered an over-crowded profession.
On April 23, 1822, Dr. Green returned to East Chelmsford on horseback. According to Dr. Green, at this time, “a gang of two hundred Irish laborers, had began on a large contract for digging the canals, and for the foundation of mill No. 1.” These three passages from his autobiography give vivid examples of life in 1822.
On the twenty-ninth of April [1822] Mr. Boott was thrown out of his carriage, descending the hill near J. L. Corliss' house. One of the Dracut doctors was in the store nearby. Mr. Boott was carried into the house, and to the surprise of the by-standers, he sent for the young stranger; this being the first professional call I had, and a most auspicious beginning.
June 4 [1822], the Dutton Street canal was finished, and the barracks of the men were removed to two large barns on the Fletcher farm, near the hosiery mill, fitted up with bunks for sleeping, and rough tables for feeding. The numbers of men were greatly increased preparatory to beginning enlarging the old canal round the falls. The nature of their employment exposed them to much accident and disease, and my early practice was much among them, night and day. In their wretched dwellings, while awaiting at the bedside of the sick, I have sometimes sat with an umbrella over my head to shield me from the dripping of a leaky roof.
On the eighth of July [1822], the greatest excitement was caused by a man being, as it was termed, blown up by gunpowder in blasting rocks. It was the beginning of a series of similar and frequent accidents. On the sixteenth, another occurred, and on Oct. 15, Russell Mears, of Tewksbury, whose case was peculiar, had made three holes, had charged two of them, and was tamping the third, when it exploded, throwing him into the air. He fell near the other holes, which exploded in succession, and no one could approach until afterwards. He lost an arm and one eye, and was pierced in all directions by the fragments of stone, some of them weighing two ounces. He recovered, however, after months of suffering and much of my anxious care. These accidents were so frequent that I had, in two years, five amputations of arms, one individual losing both hands. I was called twice to Amoskeag Falls, now Manchester, and once to Nashua, in consultation in similar cases.
As stated above, the Merrimack Manufacturing Company produced its first textiles on September 1, 1823. Late in 1823, Dr. Green and other doctors began vaccinating residents against smallpox (also spelled at that time as “small-pox” and “small pox” and sometimes capitalized). As mentioned above, for smallpox to spread among a population, people must be living and/or working close together. The people moving to Lowell from the country would likely have had no experience with smallpox and may not have even heard of the disease. They also would have had no reason to pursue inoculation or vaccination, nor would they have been exposed to smallpox and acquired immunity. Once these non-immune people came and lived close together in boarding houses and worked close together in the mills, the chance of being exposed to and contracting smallpox became significantly higher.
By 1824, there was an effective method of prevention for smallpox. In 1800, Edward Jenner (1749 – 1823) in England published A Continuation of Facts and Observations Relative to the Variolæ Vaccinæ, or Cow-Pox, where he stated that he had the pleasure of “seeing that the feeble efforts of a few individuals to depreciate the new practice are sinking fast into contempt beneath the immense mass of evidence which has arisen up in support of it.” The same year, 1800, was also the first use of the cowpox virus to prevent smallpox in the North or South America by Dr. Benjamin Waterhouse of Cambridge, Massachusetts. Because of two earlier publications by Jenner in 1798 and 1799, by the time of the 1800 publication, “[u]pwards of six thousand persons have now been inoculated with the virus of cow-pox.” This use of a microorganism was successful in preventing disease without any knowledge of germs and an understanding of Germ Theory.
Before vaccination, inoculation was used to prevent smallpox. In the second article of this series, it was mentioned that George Washington required inoculation of the troops in the Continental Army during the Revolution. Inoculation involved purposely introducing material from a smallpox pustule on one person into the skin of another person who had not had the disease. While this was effective in most cases, the risks were high because the inoculated person would get smallpox though usually in a milder form that if it was contracted by natural means.
As a city and a busy port with people arriving regularly from other cities and busy ports, along with having some of the earliest and strongest proponents of inoculation such as Cotton Mather and Zabdiel Boylston, the history of smallpox and inoculation in Boston is fascinating in and of itself. But going even a few miles outside of Boston, smallpox would not be seen as a threat. That was until cities such as Lowell began to grow so large and so quickly.
In January 1824, Dr. Elisha Huntington came to East Chelmsford from Boston with a letter to Dr. John O. Green from Dr. Wells of Boston. Dr. Huntington settled in what is now Belvidere. The same month of Dr. Huntington’s arrival, the incident mentioned in the quote at the beginning of this article occurred. More of that passage is presented here:
January 24, 1824, a stranger was taken suddenly and violently ill at Tyler's Tavern. Dr. Huntington and myself early saw that his case was uncommon and suspicious, and next morning five of the neighboring physicians were summoned, and decided it was small-pox. At this time, it was probably true that there was not in Massachusetts a physician under forty years of age who had ever seen a case, so rare was its occurrence. The consternation which ensued cannot now be easily believed. More than half the people in the mills quit work and fled in all directions. Some of the girls, in their anxiety to escape, actually walked to Newburyport. A town meeting was called, a pest- house prepared— being a rough boarded tool-house near the Guard Locks. An old man who had experience in the disease was employed as a nurse. It proved a confluent case, and the patient died Feb. 1, and was buried in the night. Soon after, two articles appeared in the Columbian Centinel, in Boston, reflecting severely upon the apathy and tardiness of action of the selectmen,---Nathaniel Wright being chairman,---the authorship of which was not in much doubt. A reply, signed by an old inhabitant of Chelmsford was made. At the town meeting, in March following, notwithstanding many threats, the old board was reëlected.
To reassure the confidence of this particularly sensitive community as soon as possible, it became necessary that vaccination should be speedy and general. Messengers were sent to several places to procure the virus, I myself going to Concord in the night for the same purpose. We were successful to a degree, so that a general vaccination was soon effected. Notwithstanding, a second case occurred on the fifteenth of March, which recovered. This was the origin of the measures which have been followed by the corporations, and which have been successful in preventing the scare in subsequent outbreaks of the disease. In one of them I vaccinated seven hundred girls.
This extended quote from John O. Green’s 1884 autobiography and the incident described in it will be discussed here in some detail. This incident will be treated as a case study the specifics of which address many of the understandings of health and disease in this period.
First of all, Dr. Green, looking back 60 years, stated that “there was not in Massachusetts a physician under forty years of age who had ever seen a case” of smallpox. The most recent smallpox epidemic in Boston occurred in 1792, or 32 years before the incident at Tyler’s Tavern, and seven years before Dr. Green was born. The vaccinations, though far from being universally applied, were having a positive effect on controlling the disease.
In “their anxiety to escape” the mill workers who fled when smallpox appeared in 1824 might seem to have been overreacting; however, smallpox was a terrible disease: It was fatal for many of its victims and disfiguring for many of its survivors. Also, in 1824, only a few people believed in germs as a cause of disease or even that germs existed. No proven direct cause between a specific germ and a specific disease would be made for a few decades. There was the sense that smallpox was spread from person-to-person, so staying away from direct contact with the active case of the disease was a good idea, especially for the unvaccinated and those without previous exposure to the disease. Most of the mill workers were unvaccinated and had not been exposed to the disease, which would have made them a “particularly sensitive community” medically and psychologically.
Preparing the “pest-house” and hiring “old man who had experience in the disease” as a nurse would have been the standard procedures at the time. In the second article in this series, there was a quote from Wilson Waters that described an incident in 1722 where the smallpox victims were isolated in their home with a fence and “notifications.” Because the 1824 victim at Tyler’s Tavern was a stranger from out of town, this was not an option, so the ad hoc pest house had to be found. The nurse who was hired likely had the disease earlier in his life and survived, and therefore had developed immunity.
In “confluent” cases, the pustules run into each other and this is the most lethal form of the disease. The patient would have been “buried in the night” to minimize any possible exposure to others, as well as to not further alarm the community.
The articles, or anonymous letters to the editor, in the Boston newspaper the Columbian Centinel mentioned by Dr. Green tell more of the story including the controversy he alluded to. The dates and other details mentioned by Dr. Green do not correspond with those in the letters, and the dates and details in the letters do not correspond with each other.
The first letter below appeared in the Columbian Centinel on January 31, 1824. It is dated January 28, 1824.
SMALL POX IN MIDDLESEX.
EXTRACT OF A LETTER TO THE EDITOR
Chelmsford, Jan. 28, 1824
“SIR--- The only case of Small Pox which has occurred in Chelmsford, is in the person of a machinist from New Jersey, employed in Hurd’s Factory, who had been in town but a few days when taken sick. As soon as the case was decided Small Pox, and previously to the period of contagion, the patient was removed to a distant building, and every precaution immediately taken, to prevent his communicating the contagion to others. A general vaccination was immediately commenced, which has been extended to every individual in the town, not previously secured by it from Small Pox. The example has been followed in adjoining towns. No other case has as yet occurred, and it is hoped that the precautions which have been taken will confine the disease to the single individual now convalescent from it. His symptoms have been exceedingly mild from the commencement. The above statement, we hope, will do away all rumours respecting the prevalence of Small Pox in this town, and all unnecessary apprehension of travellers and others; whose business may call them into this flourishing and healthy neighborhood.
Yours, &c. D.”
This second letter appeared in the Columbian Centinel on February 4, 1824. It is dated February 1, 1824.
Fatal Negligence.---A stranger from Connecticut, by the name of ALDRIDGE, having been taken sick on the 11th ult. at TYLER’s tavern in Chelmsford, was pronounced on the 18th to be Infected with the small pox. Mr. TYLER immediately applied to the nearest Selectmen, but received no aid. By his own exertions the man was removed that evening (with the consent of this officer) to an out-building, which was loaned to the town on express condition that it should be removed to a greater distance: and with this view the owners placed it upon skids. It still remains on the same spot, and in the same condition. The shed was erected as a temporary cover for tools, &c. and only consisted of rough boarding, and a single floor not jointed, and this too raised a foot from the ground, so that it was exposed on every part to the weather, except the roof, which was tight.
Great alarm now prevailed, and the more so, as no measures were taken by the proper authorities to prevent the spread of the disease by vaccination, &c. In the course of the week a town meeting was warned for the 26th, nine days after the small pox had been declared to exist in the town. This resulted in little else than having the statute read relating to small pox, upon which the Selectmen were required by the town to do what the Legislature in its wisdom had previously most explicitly enjoined. The meeting, however, were informed by the Physician that the shed occupied by his patient was utterly unsuitable, and that during the storm which continued to rage with unabated violence he had found his bed completely wet with snow. Notwithstanding this communication, the unfortunate man was left to his fate, and after passing in safety, by the unremitted care of his Physician, through all the critical stages of his disease, he fell last night a victim to the culpable negligence of those whose duty it was to have provided a suitable hospital.
AN INHABITANT OF CHELMSFORD.
Chelmsford, Feb. 1, 1824.
This third letter about the incident appeared in the Columbian Centinel on February 14, 1824, and is dated February 7, 1824.
[BY REQUEST.]
Mr. RUSSELL---- As a paragraph lately appeared in the Centinel, headed “Fatal Negligence,” which contains some exaggerations, and written as though the gentleman felt angry with the Selectmen and inhabitants of Chelmsford, because Devine Providence had permitted a case of the small pox to appear in the vicinity of the Factory, where he resides, to the temporary injury of the establishment, it is due the town and its municipal officers to state a few facts, which will palliate the crime with which they are charged.
After a council of five Physicians had declared the disease to be the small pox, word was immediately sent to one of the Selectmen, living nearest to the place, who, not having either the kine or small pox, could not himself see to the affair; he however directed Capt. Tyler, at whose house the sick man lay, to procure a suitable place, remove him, and provide whatever was necessary for his comfort. A house belonging to the corporation was obtained on condition that it be removed farther off. But no team could be procured to remove it. The agent for the corporation refused his men and oxen to assist. And such was the consternation, that it became exceedingly difficult to obtain help for the exigence. The building was not removed; but it was furnished with a stove, bed, and other utensils, and two aged and experienced nurses were engaged to tend him. No complaint was made of the house, until town meeting, when the “Inhabitant of Chelmsford” brought the attending Physician to the meeting, who stated that the house was not suitable. But the disease was regularly progressing; and no apprehension was entertained of his suffering any inconvenience from this situation; and owing to the extreme difficulty of procuring another house in that part of the town, and of removing him in that stage of the disease, he was suffered to remain. A driving storm of snow arising, he was exposed to inconvenience, more than was anticipated. Whether this was the cause of death, as stated by the “Inhabitant of Chelmsford,” is a question of which the Physician and nurses are the best judges.
As to the dilatoriness of the Selectmen in calling a town meeting, the gentleman’s remarks might have been spared; as there was no occasion for a town meeting at all, the law having authorized the Selectmen to make all necessary provision in case. The friends of the deceased will be consoled by the assurance, whatever may be said to the contrary, that he received all needful attention, having constantly with him one, sometimes two and three gentlemen, who have been much conversant with the disease. They may rest assured that there has been no culpable negligence on the part of the Selectmen or inhabitants of Chelmsford. Considering how fatal this disease has proved at Lexington, it can by no means be made certain, that Mr. Aldridge would have lived in a more commodious house. That he “fell victim to the negligence,” as the gentleman states, of the Selectmen or inhabitants of Chelmsford, must be viewed a rash and passionate assertion; and he might with as much truth and justice have said that he fell a victim to the negligence of the Physician and nurses, all of whom, it is believed, are clear from his blood.
AN OLD INHABITANT OF CHELMSFORD.
Feb. 7, 1824
The arrival of a person with an active case of smallpox was unexpected at the time yet, in retrospect, inevitable. In 1824, cases of smallpox still appeared and while an effective vaccination was available, it was not required or universally-administered. In addition, people in rural areas were far less likely to be vaccinated or immune from earlier exposure than people in cities. While the interventions of the town officials could seemingly have been more compassionate for the affected individual, they were responding to an emergency without any previously-designed plan in place.
We can assume that the vast majority of the mill workers were unvaccinated and had not been exposed to the disease, which made them vulnerable as individuals and as a community. All of the pieces were in place for an epidemic; an at-risk population, people living and working in close proximity to one another, and no effective treatment or cure for the disease. There could have been further problems as some of the mill workers might have tried to go back to their hometowns and families. If this happened after they were exposed to the virus and before vaccination, they would have brought the disease with them to other vulnerable populations.
One can only imagine how a smallpox epidemic in this nascent stage would have affected the future of Lowell. The impromptu responses of the townspeople were effective in preventing an epidemic of a disfiguring and deadly disease. The victim was isolated, the population was vaccinated thanks to the knowledge and efforts of the town’s physicians, and policies and procedures were put in place to prevent future outbreaks, as the mills and boarding houses started requiring smallpox vaccination for all employees.
In this series, we will see later outbreaks of smallpox in Lowell, in spite of precautions and timely and effective responses, though they never reached the level of an epidemic. Smallpox was not declared eradicated until 1980, the last case on the planet was in 1977. The mallpox virus only exists today in laboratories in the US and Russia.
