The Town & the City: Lowell before and after The Civil War

This is Part 5 of "The capital of the poor man" - The History of Public Health in Lowell

Part 5 - the general tenor and amount of our success (click for pdf download)

“the general tenor and amount of our success”

1837

Much of the hesitation and error prevailing among us, have arisen from the circumstance that the early friends of vaccination believed and boasted too much: they boldly asserted that vaccination was a perfect safeguard in all cases; and that, too, in the face of numerous facts, demonstrably proving that the most violent course of smallpox could not always withdraw the sufferer from the power of a second infection. It is not surprising that some persons should have seized upon the exceptions to show that, as a part of the doctrine was untrue, the whole might or must be so. Such is actually the state of things among us now: and it seems to us that if the public could be once completely enlightened as to the real degree of efficacy, these exceptions would not weigh a feather against the general tenor and amount of our success.

Dr. John O. Green, Smallpox in Lowell, 1837

This fifth part of the series covers a very brief period in the history of Lowell – from September 22, 1837 to November 7, 1837. We know the details of what happened in Lowell during these seven weeks thanks to an article written by Dr. Green and published in the Boston Medical and Surgical Journal in December of the same year.

I am including a transcription of his entire article below and then will examine the chain of events that occurred. This is a public health case study of a smallpox outbreak in a period where there were people with various levels of immunity and non-immunity. In addition, though an effective though imperfect vaccination was available, it was not universally administered or universally trusted.

In this period of history, people could be categorized as follows –

1.) unprotected (no immunity) – they had not had the disease, the variolation, or the vaccination

2.) had a non-fatal case (immunity strong, but imperfect) - 70% of initial cases survived

3.) had variolation (immunity strong, but imperfect) – inoculation with smallpox rather

than cowpox

4.) had effective vaccination (immunity strong, not perfect) inoculation with cowpox

5.) had an ineffective vaccination (possible limited immunity)

Note: Dr. Green’s article includes the term “varioloid,” which is a mild form of smallpox affecting people who have already had the disease or have been vaccinated against it.

The article by Dr. Green is included here in its entirety.

~ ~ ~ ~ ~

THE BOSTON MEDICAL AND SURGICAL JOURNAL.
VOL. XVII.] Wednesday, December 27, 1837. [NO. 21.
SMALLPOX IN LOWELL, MASS.
BY JOHN O. GREEN, M.D.
[Communicated for the Boston Medical and Surgical Journal.]

ON the 22d of Sept. last, an Irish woman, by the name of Garvey, came to this city, from Quebec, travelling mostly on foot, and bringing in her arms a child about a year and a half old. She at once resorted to the quarter of our city occupied exclusively by our Irish population, and gained admittance to the second Hilliard house, so called, on Fenwick street. These houses are five in number; they are large wooden buildings of two stories, constructed entirely with reference to this kind of tenants, and containing sixty tenements. Each tenement consists of one room, and, perhaps, a bed room; and is generally occupied by a family, in some cases of eight or ten individuals, with a large proportion of children. This whole neighborhood is composed of dwellings, similar, but not so capacious; and the whole street and group, for dense population, filth, and the utter destitution of every essential to health and virtue, certainly cannot be equalled by any of our elder cities.

The women of this house, where Mrs. G. gained admission, very soon discovered that her child was ill with the smallpox, and somewhat unwilling to expose their children, obliged her to take possession of a chamber in the attic. She was kept in this room until Sept. 25, three days, when their apprehensions getting the better of their hospitality, they supplied her with money, and she took the half-price car on Monday morning, September 25th, for Boston, with her sick child in her arms. Here she forthwith repaired to the Worcester Rail Road office, and thence to Worcester. The child lived until she reached her husband, who was at work on the Western Rail Road, about four miles from Worcester, where it died at an advanced stage of smallpox.

On the 10th of October, an Irishman, very unintentionally, divulged the secret to one of the health commissioners, that there were some supposed cases of smallpox in the quarter of the city above named; and in the afternoon of this day, I found four children sick with the disease. They had been most carefully concealed by their parents, although some of them were as far advanced as the sixth or eighth day, with confluent smallpox.

When we take into view the crowded state of this population, their peculiar habits of associating together, especially about the sick, their want of cleanliness, their repugnance to vaccination, from ignorance of its advantages (nearly all the adults having had the smallpox), and the fact that the disease had been here concealed most studiously for nearly three weeks, it is at once apparent that no other course than the speedy removal of the infected, seemed consistent with the public safety.

Accordingly, on the morning of October 11th, in two hours, no less than eleven children, in all stages of the disease, were detected and removed to the hospital. Of these eleven, six were from the house where Mrs. G. staid; four were from the adjoining, distant only five feet ; and one from another house, about six rods off, on the same side of the street. The whole number eventually removed from the house in which it first appeared, was nine; in fact, every individual in that house who had not had smallpox, took it, except one infant protected by vaccination.

The subsequent admissions to the hospital were as follows:

Oct. 11, 11 cases from Fenwick st. Oct. 12, 1 case from Fenwick st.

Oct. 12, 1 case from Suffolk st.

Oct. 13, 1 case from Lawrence Corp. Oct. 14, 1 case from South st.

Oct. 21, 1 case from Fenwick st. Oct. 22, 2 cases from Fenwick st. Oct. 23, 2 cases from Fenwick st. Oct. 24, 2 cases from Fenwick st. Oct. 27, 3 cases from South st.

Oct. 30, 1 case from South st. Nov. 3, 1 case from Lowell st. Nov. 6, 1 case from Fayette st. Nov. 6, 1 case from Appleton st.

It will be observed that nineteen cases were from Fenwick street, where the disease began. Twenty- five [out of 29] were under ten years of age, and seven cases [out of 29] were fatal. Up to the 3d November, when we had had twenty-nine cases, it was very easy to trace the manner in which each individual had contracted the disease. After this time, it was not possible to do it.

The facts connected with the Johnson family are sufficiently interesting to require distinct notice. In the same car in which Mrs. G. and her child went to Boston, September 25th, also went Mr. Johnson. On Monday evening, October 9th, he was attacked with violent febrile symptoms. On Thursday evening following, an eruption began to appear upon him, which was pronounced to be smallpox on the following day, and October 14th, Saturday evening, he was removed to the hospital. His case proved to be confluent nearly all over the head and trunk, characterized early by

great oppression of the brain, the pock with purplish centres and large blisters of dark-colored serum interspersed. He died on the afternoon of the 21st, on the 12th day of the disease.

At the time of his attack, his family consisted of his wife, six sons, the eldest fourteen years old, two female domestics, three male and two female boarders; in all, fourteen persons. They had all had the vaccine disease but the six boys and two of the boarders. The day the disease was declared to be smallpox in the father, they were all vaccinated with several quills in each. On the following Monday, the vaccination was repeated. In the course of that week it was repeated again, and on Monday, the 23d, it was again done by a neighbor from a fresh arm. The result was as follows.

William, the eldest, escaped entirely, his vaccination of the 16th being successful, as was also that of the two boarders.

Joseph, aged 11, was seized violently on the evening of Friday, the 27th. He had excruciating pain in the abdomen, limbs and back, incessant vomiting, and delirium. On 28th, entered the hospital, and on the 30th the eruption commenced on the chest and neck. At this time his vaccination of the 23d was perfect. Upon each arm I never witnessed a more regular and beautiful vaccine pustule. As the eruption appeared, his symptoms mitigated, although previously very threatening. He went through the smallpox with a copious but distinct eruption, and without the least modification, unless it was that the pustules upon the face were uncommonly small. The vaccine pustules were eventually nearly destroyed by the encroachment of the variolous ones.

Cyrus, aged 9, went into the hospital with the rest of the family on the 28th, but did not complain. On the 29th he began to erupt. He had a very moderate eruption of variola, and kept about all the time. His vaccination of the 23d produced a little pale red conical tumor, with a good deal of surrounding redness, but soon disappeared.

Charles, aged 7. His vaccination apparently produced no effect. He sickened on the 23d, and had a copious, distinct, variolous eruption on the 26th. The disease was perfectly regular, but severe. Andrew, aged 5, had the disease with about the same violence as Charles, his vaccination never having shown any effect. He was attacked and entered same time as Charles.

Horace, aged 2. His arm, from the vaccination, put on the same appearances as that of Cyrus. He had variola at the same time and with the same mildness as Cyrus, not exceeding one hundred pustules.

One of the domestics, aged forty-five, says she was vaccinated by a physician about eight years ago. She has a large, deep scar upon the arm, but without the indentations which are characteristic of the vaccine scar. She watched with Mr. Johnson on the night of the 10th. On the 23d she had slight illness, and on the 26th, a pretty copious eruption on the face and neck only. These papulae went on to enlarge, and on the fourth day were conical, without any central depression. On the

fifth they were filled with opake matter, and soon began to desiccate, so that on November 6th, having had a mild varioloid, she was well. The other members of the family escaped without any sickness.

Edward Kelly, a neighbor, aged twenty-three, watched with Mr. Johnson October 13, and was engaged to remove some bedding after Mr. Johnson was carried to the hospital. He was inoculated with smallpox when he was nine months old, and has its scars, and also scars on the face. With very little constitutional disorder, on the 25th, he broke out with a very copious pustular eruption upon the face and chest. He entered the hospital on the 30th. In nine days, that is, November 3d, the scales had all fallen, leaving indurated knobs under the cuticle. This was the second varioloid. Mrs. D., a sister of Mr. Johnson, who was with him some hours about the time he began to break out, and visited him in the hospital 'the day before he died, and who had the vaccine disease about ten years ago, with a perfect scar, was attacked with severe premonitory symptoms, October 21. A single pustule appeared on the hand, October 25th, and a dozen others followed on the face and scalp, constituting the third varioloid.

The coexistence of the variolous and vaccine diseases was equally as striking in two other cases in the hospital, as in the case of Joseph Johnson. In each of these two, there was no apparent modification, unless in the smaller size of the pustules in the face, which was certainly true in all. It is worthy of note, that in the family on the Lawrence corporation, consisting of forty-six females, one of the largest boarding houses in the city, the individual attacked with the smallpox was the only unvaccinated one in the house; and no other case followed on that corporation.

Among twenty-four persons employed at the hospital as nurses and attendants, seventeen had had smallpox, and seven the vaccine disease. One of the former had a single variolous pustule upon the hand, yet none of the latter were in the least degree affected. Of fifteen physicians who made occasional visits to the hospital, not one suffered at all.

In Fenwick street and its immediate vicinity, the Irish, with great willingness, brought forward their children for vaccination. On the 12th of October, two days after the disease was discovered among them, 197 children were vaccinated. On the 17th, 19th, and 23d of October, and lst and 7th of November, 200 more, so that not less than 400 were vaccinated in that neighborhood. The last case of smallpox from this street was October 24th.

We do not mean to have it understood that vaccination was confined to this quarter of the city. There exists among all the incorporated companies here, a permanent arrangement which insures to every individual in their employ, and to their families, this privilege without expense. Through this arrangement the number vaccinated each year is very large, and shows the fearful extent to which our country villages are unprotected. There is, of course, an increased demand for the operation whenever smallpox appears among or near us. Within the last fifteen years, the term of

my residence here, we have had several alarms. In January, 1824, a fatal case occurred in this town. In March, 1824, another case, which recovered. In November, 1833, a single case at Billerica mills, about four miles from this. In December, 1835, a single case at Dracut, about one mile from our mills. In February, 1837, two cases in this city. These, together with the present, constitute all my experience with the smallpox. Limited as it is, however, and as it must be to every practitioner under forty years of age in New England, it seems to me to add some additional weight to the following propositions, viz.:

1. That our confidence in the protective power of vaccination needs not to be impaired.

2. That the number of cases of varioloid, even under circumstances of great exposure to the worst forms of smallpox, is very small.

3. That vaccination has no power of preventing or even modifying smallpox, if not had recourse to before the system has become contaminated.

4. That those who are successfully vaccinated three days after the exposure to smallpox, will escape.

5. That length of time has no tendency to diminish the effect of kinepox in the prevention of smallpox.

6. That the kinepock is a better protection against varioloid than smallpox the natural way or by inoculation.

In our vaccination on a large scale for the Companies, the following mode is the most general—in fact, nearly universal. It combines economy of time and materials with the greatest certainty. A portion of the crust is pulverized and rubbed up with water, so as to form a fluid paste, at the time of using it. The puncture is made with the lancet in the usual place, and a quill, dipped in this liquid, is inserted and allowed to remain about ten minutes. A further saving of time may be effected by pointing the quills with the paste and allowing it to dry upon them. But they should be prepared only a short time before using. The number of failures, even with a crust three or four months old, will be surprisingly small.

In vaccinating individuals, the surest mode is the insertion of a small portion of the crust, in its dry state, with the point of a lancet.

Much of the hesitation and error prevailing among us, have arisen from the circumstance that the early friends of vaccination believed and boasted too much: they boldly asserted that vaccination was a perfect safeguard in all cases; and that, too, in the face of numerous facts, demonstrably proving that the most violent course of smallpox could not always withdraw the sufferer from the power of a second infection. It is not surprising that some persons should have seized upon the exceptions to show that, as a part of the doctrine was untrue, the whole might or must be so. Such is actually the state of things among us now: and it seems to us that if the public could be once completely enlightened as to the real degree of efficacy, these exceptions would not weigh a feather against the general tenor and amount of our success.

Detail of G. W. Boynton’s 1845 Plan of the City of Lowell showing Fenwick Street and other streets mentioned in
Dr. Green’s article. Number 10 on the map is Saint Patrick’s Church.

Dr. Green’s article and the calendar show how quickly smallpox could spread in a densely populated area in that period of history. It is fortunate that many in this population had immunity from smallpox because of prior exposure, variolation, or vaccination. One can only imagine its spread in an unvaccinated population of this density where at least a 30% mortality would be likely, and could possibly be as high as 80% for children.