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“this severe visitation”
1871
Early last year small-pox made its appearance in our city. As this disease had been, more or less prevalent in preceding years, neither our citizens nor the Board of Health gave the subject much practical attention. As the season advanced, however, it was found to be prevailing in almost every section of the city; and that the most stringent and energetic measures must be taken. A new Board of Health was elected, who, calling to their aid our most experienced physicians, soon had the disease under control, and finally entirely eradicated. For the time, the effect was most disastrous to the business interests of our city, involving the loss of many valuable lives. Let the sad experience of this severe visitation admonish us as to our duties in the future in every matter pertaining to the general health and cleanliness of our city.
The amount appropriated was $28,072.71; expenditures, $26,730.42; balance undrawn, $1,342.29.
Mayor Josiah G. Peabody, January 1, 1872
This chapter discusses the 1871 smallpox epidemic in Lowell. It illustrates the value of effective laws that protect the public, effective public health measures, and an effective Board of Health. Like a before and after photograph, this is a case study of the consequences of not having and having these measures in place.
Two earlier sections of this series examined smallpox outbreaks; one in 1824 when today’s Lowell was still East Chelmsford, and the other more widespread and deadly outbreak in 1837. Thirty-four years after the 1837 outbreak and seven decades after the kinepox (cowpox) vaccination was discovered by Edward Jenner, Lowell was hit with a full-blown epidemic of smallpox lasting about eight months with a total of 570 cases and 172 deaths.
There was a smallpox pandemic in Europe that lasted from 1870 to 1874, The epidemic began in London and Liverpool in the last quarter of 1870 and spiked in those cities in 1871. Smallpox accounted for 9.84% of all the deaths in London in 1871. For comparison, smallpox accounted for 1.25% of London’s deaths in 1870, and 2.50% in 1872. It is likely that smallpox was brought from England to the United States, where epidemics in New York caused 293 deaths in 1870 and 805 deaths in 1871.
While smallpox seemed to disappear from specific areas for long periods of time in the US in the 1800s, it continued to survive in places around the world where there were enough non-immune people to continue ongoing chains of contagion. While the virus can remain virulent outside a human body on items such as clothing and blankets for a few weeks, it cannot reproduce unless it is inside a human body. Then, if enough non-immune people are in close proximity to each other and the virus is introduced to the population, there is an outbreak, epidemic, or pandemic. The chain of contagion continues until the virus can no longer jump to new susceptible hosts.
By 1871, it was well-established that vaccination was effective and had few serious side effects. This was accepted by many lawmakers and members of the public in the US, but this acceptance was by no means universal. While some politicians realized the benefit of laws that required vaccination and isolation of the sick, there was enough pushback to allow the virus to attack anywhere at any time. Even when laws existed, many in authority considered them unenforceable and/or refused to enforce them.
There were three cases of smallpox in Lowell one year earlier in February 1870. According to the Report of the City Physician for that year, the first case “broke out” at No. 18 Green Street.
The person attacked contracted the disease in Boston and communicated it to two others. At a meeting of the City Board of Health, isolation was recommended and decided upon as the best means that could be adopted to prevent the disease from spreading. But there being no pest-house or other suitable building of the requisite distance from the main buildings at the City Farm, one had to be sought among the private houses. Fortunately, without much delay, a vacant house was found, in the southern part of the city, sufficiently separated from other houses; this was taken possession of, and the first case, with his family, was removed thereto, and the other two cases also soon after the disease made its appearance. The tenements which they left were thoroughly disinfected, and the people living in the vicinity were vaccinated. By these means the disease was stamped out and its spread arrested.
Report of the City Physician, 1870
The responses of Lowell’s government one year later can serve as a case study for both how to and how not to respond to a contagious virus. Unfortunately, we did not learn much, or enough, from this or other 19th and 20th century epidemics to prevent or mitigate the COVID-19 outbreak in the year 2020.
Unfortunately for the victims of the disease at the time, this story is filled with political arguments, controversies, and conflicts. A discussion of the epidemic shows that a lot more could have been done early on to shorten its duration lessen the number of cases and deaths. It is important to remember that at this time in US history, the was no guidance from the federal government and very little from state governments that could help local areas control contagious diseases. As we will see, professional medical advice was local and was often suspect or ignored.
Two reports and a biography
There were two reports written at the end of the epidemic. These reports are almost identical, but the small differences, between both the reports and the titles, give us some indications of the political conflicts at the time.
The titles of the reports are as follows;
Complete Report of the Board of Health, and Board of Consulting Physicians, as presented to the City Council, December 12th, 1871, and Small-Pox in Lowell: Reports of the Board of Health and of the Consulting Physicians, as accepted by the City Council, December 12th, 1871, which is in City Documents of the City of Lowell for the Year 1871-72. The information presented in both reports is more important to describe the epidemic. The differences between them, which is of more political interest will be discussed after chronicling the course of the epidemic and its effects on the people of Lowell.
There was also a book, The Reminiscences of Frederick Ayer (1923), which was dictated by Frederick Ayer to his daughter, Beatrice Ayer Patton, after he was eighty-five years old, and also includes sections written by the daughter, and his son, Frederick Ayer, Jr. Frederick Ayer became the Chairman of the “new” Board of Health in September of 1871. The epidemic is mentioned in a few pages of the book, which adds background and details to the story.
The start of the epidemic
According the Reports “There appears to be some uncertainty respecting the origin of this disease in our city.” At the same time, the first case in Lowell was reported to be in a family living on Mill Street in January of 1871 with the last name Kennedy. The father of the family came to Lowell from Liverpool six months earlier. We can assume that the family came from Liverpool as well. It seems that two of the children came down with smallpox although the
family were all in apparent good health, and no contagious disease was known to exist in the vessel in which they came over. Furthermore, all the family had been vaccinated in England. Some two weeks after their arrival, a girl, eight years of age, was taken ill with an eruptive disease, which was supposed to be scarlet fever. Ten days after, a boy, three and a half years of age, was taken sick and died on the 29th of January. His death was reported as caused by scarlet fever. No physician had been in attendance, and no small-pox was suspected until some days after his burial. At this time a child living near by was taken sick, and a suspicion arose that it might be a case of small-pox. The proper authorities were notified, an investigation was made, and the case was found to be one of small-pox. The Kennedy girl had at this time the eruption remaining on her face, which still bears the distinctive marks of the disease. The presumption at first would seem to be, that the disease was contracted on her passage, or on her arrival in Boston; but another and more probable interpretation of it is, that it was contracted through the use of a second-hand mattress, which had been bought at auction, just before the arrival of this family, and which had every appearance of having had hard service. Both the Kennedy children slept on this mattress. No other cases occurred at the time in the neighborhood, but the disease soon appeared in a number of other and distant localities.
Both reports contained this section
Lowell Advertiser, February 9, 1871
I have not found any of the details that would either support or refute the idea of the mattress being the source of the outbreak; however, I do not see why the virus could not have been brought to the US by the poor souls immigrating from Liverpool, which we know was a hotspot for the virus at that time. While nothing is known about the provenance of the mattress, an infected human would have to had used the mattress fairly recently before the infection. It seems that there would have been a case of smallpox close in time and proximity to the first infections to whom the mattress could be traced, especially in a New England winter where smallpox would not survive for long outside the human body. The lack of identified or active cases on the vessel from England, the good health of the family upon their arrival, and their previous vaccinations do not rule out these unfortunate children as unwitting carriers.
All that said, one way or another, smallpox made its way into Lowell in 1871, and it was established and spreading, because that is what viruses do. Unfortunately for humanity, that is all that viruses do. The cases increased.
Smallpox cases and deaths
By April 10th, the City Physician reported that 35 cases had come to his knowledge. From April 10th to May 15th, the “new” Board of health, established later in September, was unable to obtain the exact number of new cases for an unstated reason, but their report estimated that there might have been 15 to 20. Then on May 16th, the City Marshal’s office began to keep a record:
May 16th to June 1st - 21 cases;
June - 32 cases;
July - 61 cases;
August - 93 cases;
September 1st to the 24th - 143 cases, then this record closed.
The reporting of cases continued under the new Board of Health:
September 24th to October 1st - 69 cases (making a total of 212 in September);
October - 94 cases;
November 1st to the writing of the report - 6 ca.ses.
The report of the Superintendent of Burials gave the following record of deaths from smallpox:
March - 4
April - 6
May - 17
June - 8
July - 22
August - 29
September - 55
October - 30
November - 1
Total - 172
This is another list of the number of deaths by month and I have added the numbers of cases for the month in brackets:
March - 4
April - 6
May - 17
June – 8 [32]
July – 22 [61]
August – 29 [93]
September – 55 [143]
October – 30 [94]
November – 1 [6]
Total - 172 [570]
There was a similar rise and fall for the epidemic of cholera in 1849 Lowell, but the reasons, and the pathogens, were very different. Cholera, caused by water-borne bacteria, was a summer and early fall disease in New England. When the weather got hotter, the bacteria thrived, when the weather got colder, it died. Smallpox, a virus, doesn’t die in cold weather, as evidenced by the first cases of smallpox appearing in January, February, and March. It also was not going die out without human intervention.
There was a change during the month of September and it was caused by human intervention, not a change in the disease or the virus itself. The difference was between the actions of the “old” and “new” Boards of Health.
The “old” Board of Health
Early in January, when the small-pox was first discovered, an effort was made by the Board of Health to place the infected district under quarantine, by hanging out the red flag, by barricading the streets, and by preventing communication with the district. But in a short time the disease appeared in so many new localities, that all attempt at isolation was abandoned. Where parties would tolerate its appearance, the red flag became the signal of the existence of the disease, and at the same time, almost the only barrier to its extension. Physicians were notified by the Board of Health to comply with the law in reporting all cases of small-pox or varioloid coming under their observation, and a record of the same was kept at the City Marshal’s office, after the middle of May.
On the 10th of April the Board of Health ordered a general vaccination throughout the city under the direction of the City Physician. There were vaccinated at this time about eight thousand persons, and during the summer, one thousand more. As the small-pox steadily increased, efforts were made by the Board, the City Physician and City Marshal, to induce persons attacked with the disease to be removed to the hospital provided by the city. But few would consent to such removal, and the Board of Health considered that they had no right, or legal power, to cause such removals.
At sundry times the public were assured by official authority, that the number of cases of small-pox in the city was very limited, and the expectation was held out that the epidemic would soon come to an end.
Both reports contained this section
Actions of the North Middlesex District Medical Society
The North Middlesex District Medical Society held a “regular meeting” on July 26, 1871 and discussed the smallpox epidemic. Some of the Society’s members felt that the medical profession had been “unjustly censured” by the public for not doing enough to fight the epidemic, while others said that their advice had been “wholly ignored” by those who were supposed to be in charge.
The opinion was very generally expressed at this meeting that by proper measures this epidemic could be suppressed in a short time; and with the desire of having some efficient measures taken in this direction, the following resolution was unanimously passed:
“That in view of the present condition of our city, in regard to the prevalence of small -pox, we, as members of the medical profession, respectfully suggest that, in our opinion, in order to effectually suppress or control the disease referred to, a distinct commission should be created by the City Government, whose exclusive duty it should be, so long as may be necessary, to do all in their power, by proper and legal means, to get rid of the disease now existing in our midst.”
Both reports contained this section
So, some five or more months into the epidemic a non-governmental organization of medical professionals unanimously passed a clear and polite resolution stating that things weren’t going well and that things had to change. The result of this was . . . nothing, at least for six weeks.
By some inadvertence this resolution was addressed to the City Council, when it was intended for the Board of Health and was delivered to its chairman. . . This resolution was presented immediately to the Board of Health which, (after determining that it had no power to make such changes,) transmitted the same to the City Council at its meeting, September 12th, a lapse of nearly six weeks intervening. After considerable discussion in the Council, this resolution was referred to a committee to consider and report upon, at an adjourned meeting, September 15th. This committee made a report to the City Council, introducing a new ordinance, providing for a temporary health commission, consisting of six persons — one from each Ward — with particular reference to the removal of the small-pox. But as it was thought by some that the operation of such a commission might conflict with the action of the Board of Health, another ordinance, with some changes, was proposed and adopted, which virtually displaced the old Board and led to the establishment of the new one. In the meantime the agitation of the subject, in the community, resulted in petitions to the City Government, extensively signed, urging them to take immediate measures for checking the progress of the disease. Thus the action taken by the Medical Society became, unexpectedly, the occasion of an important change in the City Council.
Both reports contain this section
The “new” Board of Health
As mentioned above, the Board of Health submitted two reports at the end of the epidemic. There were a few small differences between the reports, but examining the differences points out the political battles that took place during the crisis. The two titles were Complete Report of the Board of Health, and Board of Consulting Physicians, as presented to [boldface added] the City Council, December 12th, 1871, and Small-Pox in Lowell: Reports of the Board of Health and of the Consulting Physicians, as accepted by [boldface added] the City Council, December 12th, 1871, So, one version was “presented to” the City Council and the other was “accepted by” the City Council and is included in City Documents of the City of Lowell for the Year 1871-72.
The following communication from the Board of Health to the City Council was inserted in the “presented” document:
LOWELL, MASS., 12th December, 1871.
To the City Council:
The Board of Health, to whom was recommitted their Report of the 28th ult., with a request to amend, by striking out the following, to wit:-
"The motives which induced the City Government to elect the Board of Health, as at present constituted, were well understood by Its newly-elected members and by the public generally, and were, we are constrained to say, not such as to inspire the utmost confidence in the sincerity of the choice then made"-
"1'he ruling of the Mayor, that we should be obliged to serve or vacate our seats as members of the City Council, we ascertained and knew to be wholly erroneous"
"And many lives were being sacrificed"-
Have given a candid consideration to the same, and report:
That they find the statements correct, and essential to a full exposition of accepted facts; that they are necessary to a complete record; that they tend to show under what circumstances this Board of Health was chosen ; how its members were threatened with expulsion from the City Council , if they declined to serve; that the ruling sought to be imposed was erroneous; and why, finally, under the pressing exigencies of a great public calamity, in connection with other facts stated in the Report, the Board consented to serve. The Report is couched in respectful language, gives the facts in mild and unexceptionable terms, while in our opinion they would justify severe comment. Therefore, the Board of Health respectfully decline to accede to this request, or make any change in their Report, and herewith return the same as originally presented.
Respectfully submitted.
FREDERICK AYER,
HENRY C. HOWE,
BENJ. WALKER, } Board of Health
H. C. CHURCH,
ABEL T. ATHERTON,
The following extended quote was taken from the pages of the book, The Reminiscences of Frederick Ayer (1923):
It always seemed to me that my father, Frederick Ayer, took more pride in his part in suppressing the small-pox epidemic in Lowell in 1871 than in any other achievement of his career. He recounted the events of this period to me a number of times, and the following sets them forth to the best of my recollection :*—
“A small-pox epidemic had Lowell in its grip to a degree approaching hysteria. † Deaths occurred with such rapidity that burials were being made at night to attract as little attention as possible and for fear that a panic would seize the city, necessitating the closing of all the mills and other industries. Substantially nothing was being done by the Board of Health to combat the epidemic, and my father, who was then an Alderman, ‡ was very outspoken in his criticism of the inertia of the Board of Health and City administration. This resulted in his election (or appointment) to the Board of Health, and the immediate resignation of all the other members. § At this juncture he was confined to his bed in a rundown
* Written by Frederick Ayer, Jr.
†The epidemic began in January, 1871, and reached its climax in September of that year. The total number of cases for the entire epidemic was upwards of 570, with 192 deaths.
‡Elected to serve for one year from the first Monday in January, 1871.
§ This is not strictly accurate. The trouble was precipitated by the District Medical Society, which passed a resolution on July 26 recommending that a special commission be created by the City Government to combat the disease, but by inadvertence sent it to the City Council, instead of to the Board of Health, as was intended. This caused a bitter controversy, and on September 15 an entirely new Board of Health of five members was elected, Frederick Ayer being designated as chairman, the other members named being Abel T. Atherton, Henry C. Howe, Benjamin Walker, and H. C. Church.
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condition and suffering from a severe attack of boils. He was not in condition to accept, and did not wish to undertake the responsibility thus placed upon him, but the morning found all the important mill owners sitting on his doorstep, begging him to take hold of the situation and prevent a general closing of the industries of the city, saying that no one else could do it. He finally acquiesced and, once committed, acted with vigor. The new Board was organized on September 18, and at once appointed a Board of Consulting Physicians, seven in number, to take charge of the medical situation.
“The difficulties to be surmounted were calculated to discourage anyone, as they had the old Board of Health. Vaccination was regarded with great suspicion. There were no laws (and the urgency of the situation did not permit waiting for legislation) for compulsory vaccination* and for the moving and isolation of patients, for compelling common carriers to fumigate, or any such measures for the prevention of the spread of the epidemic. Neither was there a suitable hospital † nor a sufficient supply of nurses.
“In handling the legal situation my father had the able and whole-hearted co-operation of his attorney, Mr. A. P. Bonney. They conferred with the Governor and decided that (with the situation as critical as it was, and with the Governor’s promise to support them in so far as he was able) they would take such measures as were called for, regardless of legal authority, and trusting in popular sentiment to back them up. Accordingly a force of volunteer special police officers was sworn in,
* In point of fact there were such laws: on April 10 a general vaccination had been ordered, and about 9000 persons were vaccinated.
†A special small-pox hospital had been provided by the city, but the only reason it had sufficed was because the old Board of Health mistakenly considered that it had no legal right to enforce removals.
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and compulsory vaccination of everybody was inaugurated* I believe serum and medical advice was secured from the Johns Hopkins Hospital at Baltimore. This institution also supplied a considerable number of sisters, who at that time occupied the position of the trained nurse of to-day. A wooden hospital was built outside the city exclusively for small-pox patients, and this structure was completed within a week. All public vehicles were compelled to be fumigated with burning sulphur every night. This treatment was also applied to all the doctors, who were put into a box with only the face protruding, and thus fumigated between visits to patients. The Fire Department was called out every night to wash down the city streets. All dwellings where cases of small-pox occurred were immediately isolated, and a guard was put over them to enforce this isolation. In case of death or the removal of the patient, the patient’s bedding and such articles were taken and burned and the house fumigated.
“The greatest difficulty occurred in the enforced moving of patients, to which strenuous objections were raised. One of the first was the case of a grocer who lived over his store, and whose daughter had contracted the disease. He barricaded his door and appeared in an upper window announcing that he would shoot any officer who attempted to force an entrance. Volunteers were called for to move this patient, and practically the whole police force responded. When a detail armed with crowbars and implements for forcing entrance was sent to move the grocer’s daughter, he reconsidered and offered no resistance. After this no further difficulty was encountered. The result was a complete vindication of
*About 15,000 persons were vaccinated at this time.
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these aggressive methods, and within a very short time the epidemic was completely stamped out.*. . .”
*The number of cases and deaths for the most critical period of the epidemic tells its own story:
Month Cases Deaths
September 212 55
October 94 30
November 6 1
___________________
The end of the excerpt from Reminiscences of Frederick Ayer
Conclusions
This epidemic was both a tragedy and a success story with themes that are still playing out today, and with lessons that we still have not learned. While we can know a lot about the events of the time, there are also some missing parts to this story and some remaining questions.
Why didn’t the “old” Board of Health act more forcefully early in the epidemic? It seems that they believed that they did not have the power to take some of the more forceful measures involving vaccination, isolation and removal of the sick, and required reporting of cases, even though there were state laws addressing these on the books at that time.
Was the Board of Health told that the city would not or could not back them up with enforcement measures? Were they being given guidance and legal advice that made them reticent to act? Did people think that this was a temporary problem that could be isolated in a certain area of the city and would disappear?
Why were other parts of the city government, elected and appointed, not pressuring the Board of Health to act? Why wasn’t the Board of Health given the support, guidance, and legal advice to take effective measures? Did the realization that the disease had spread to all areas of the city and all classes, which would affect the corporations, cause other city officials to take notice?
Why was the District Medical Society needed to intervene? Why was their intervention so controversial? Why was their resolution, at first, ignored? Their resolution was inadvertently addressed and sent to the City Council rather than the Board of Health, but why did this effectively bury it for six weeks? Why was the new Board of Health able, allowed, and even supported in implementing stricter and more aggressive rules?
The empowering of the Board of Health and its Chairman, Frederick Ayer, who already had political and corporate power, money, a good lawyer, and the ear of the governor, enabled them to initiate changes that came together to create an effective response. A few things happened at the same time; the governor promised to support the new initiatives as much as he could, the police enforced rules and laws, there was a new small-pox hospital with assigned physicians and sisters who cared for the patients, and the Corporation Hospital admitted smallpox patients and provided good care. The better and humane medical and nursing care increased the confidence and comfort of the public. This led to a shift where hospitals were not seen as death sentences, but were places where the infected would be cared for while protecting the community at large.
