City Document.-No. 30. ©HW ©S' JB©S^©Bo MEMORIAL IN RELATION TO THE SMALL POX. 1 8 5 6. In Board of Aidermen, March 13, 1856. Laid on the table, and ordered to be printed. Attest: S. F. McCleary, City Clerk. MEMORIAL IN RELATION TO THE SMALL POX. To the Mayor and Aldermen of the City of Boston : The memorial of the undersigned respectfully repre- sents :-That in his judgment the sanitary condition of the City should receive the most watchful care of the official authorities. Whenever a contagious disease prevails, effectual measures should be adopted for its irradication and prevention, especially if it be such an one as is controllable by any remedies within the power of the City to use. The justice and expediency of this principle has long been acknowledged by the City, by the removal of nuisances, by the erection of hospitals for the accommodation of persons sick with the cholera, and by other means. The long existence and extensive prevalence of the small pox, it seems to the under- signed, has not received that attention from your hon- orable Board which its great importance and the sad consequences that have resulted from it demand. The Report of the Sanitary Commission of Massa- 4 SMALL POX. [April, chusetts, written by the undersigned, and published in 1850, contains the following among other recommend- ations for the promotion of the public health, (pp. 180, 181). 44 XXVII. We recommend that every city and town in the State be required to provide means for the periodical vaccination of the inhabitants" In the illustrations of this recommendation, it is stated in the Report that vaccination was first intro- duced into this country in 1800 ; 44 and that in 1810, an act was passed in this State, providing 1 that it shall be the duty of every town to choose persons to superintend the vaccination of the inhabitants with the cow-pox.' This law was repealed in 1836 ; and the Revised Stat- utes provided 4 that each town may make provisions for the inoculation of the inhabitants." This substitution of the word may for shall left it optional with towns to do or not to do it; and it has caused the loss of many lives. Under the operation of the old law many towns were accustomed once in about every five years, to have a general vaccination of the inhabitants; but this cus- tom, as far as our knowledge extends, has been gener- ally discontinued, and the inhabitants have thus been left liable to the disease from every new exposure." * * 44 During the twenty-six years, prior to 1837, the dis- ease caused the death, in Boston, of thirty-seven per- sons only ; and most of these were at Ramsford Island. It seldom occurred in the City proper. During the twelve years ending December 31, 1849, since the repeal, it caused the death of live hundred thirty-three persons ! And in the first six months of 1850, one hun- dred and forty six died! These were unnecessary deaths- they might and ought to have been prevented! and so 1856.] CITY DOCUMENT-No. 30. 5 should the thousands of cases of sickness by the same disease, which did not terminate fatally. The plan of house-to-house visitation, described in our twenty-fourth recommendation, [See Report, p. 168,] might have been adopted. The City might have been divided in small districts, to each of which a physician might have been assigned, who should have been required to visit every family, whether invited or not, and to vaccinate, or revaccinate, every person, if necessary or expedient. By this plan the disease would soon have been deprived of subjects to feed upon, and must have been starved out. It might thus have been expelled from the City in less than a month; and the lives of more than one hundred persons which have now been lost in less than six months might have been saved. The public expense, too, of such a measure would have been far less than that of the small-pox widows, and the small-pox orphans, which have been thrown upon the City for support, to say nothing of other expenses; and the various other marked effects and calamities of the disease, suffered more privately, might have been avoided. " Under existing circumstances, it becomes the special duty of every person to protect himself against the dis- ease. Any one who permits himself to be sick with it, is as justly chargeable with ignorance, negligence, or guilt, as he who leaves his house open to be entered and pil- laged by robbers, known to be in the neighborhood. And upon that State, city, or town, which does not interpose its legal authority to exterminate the disease should rest the responsibility, as must rest the conse- sequences of permitting the destruction of the lives and health of its citizens." 6 SMALL POX [April, These statements were believed to be correct when written; and their truth has been fully confirmed by the more full details of history. The provision of the Revised Statutes required the municipal authorities in the State to remove persons sick with the small-pox to hospitals prepared for the purpose ; or when such removal was impracticable, to cut off all free communication with them, and to give public notice of the presence of the disease by display- ing red flags and other means ; and imposed a penalty on housekeepers and physicians who did not report cases of the disease coming under their care. Under these wise provisions a hospital existed on Rainsford Island, to which patients in Boston were removed ; and to these salutary regulations must be attributed the com- parative exemption of the City from the disease, during a long period. In 1837, an act was passed giving dis- cretionary power to the authorities whether or not to remove such persons. In April, of the same year, a petition signed by John C. Warren and thirteen other physicians and seven prominent citizens of Boston, was presented to the Legislature, praying for the repeal of the 16th, 17th, 38th, 40th, 41st, 42d, 43d and 44th sections of the 21st chapter of the Revised Statutes, and for removing all restrictions in regard to the small- pox, placing it upon the same foundation as regards the sanitary police as measles, scarlatina or any other dis- ease. On account of the lateness of the session, the committee reported a reference of the subject to the next Legislature, (House Document, 1837, No. 65.) A similar petition was presented to the Legislature of 1838, when the Special Committee to whom it was 1856.] CITY DOCUMENT, No. 30. 7 referred reported in its favor, (House Document, 1838, No. 63.) The committee recommend the repeal,-1. Be- cause " it violates the sanctity of home, by removing children from parents, or parents from children, or friends from friends, or by invading private rights. 2. Because its tendency is to give false security to the community, which operates as an apology for neglect- ing the only proper means of protection against the dis- ease, which is careful vaccination." And 3. " Because it obliges physicians and housekeepers to report cases, or exposes them to heavy penalties, the publicity of which always creates a panic, disturbing the quiet of the neighborhood, unnecessarily interrupting business, causing troublesome inconvenience, and unnecessary expense." Although the act of repeal was opposed by the undersigned and others as unwise, and the above reasons pronounced fallacious, as subsequent history has fully proved, yet it was passed. In the meantime the subject was under consideration in the City Council of Boston; and on the recommendation of the Con- sulting Physicians, (See City Document, 1837, No. 1,) the removal of patients to Rainsford Island ceased after the 1st of March, 1837. Immediately, contrary to the predictions of the advocates for the repeal, the disease became prevalent in the City, as a statement presently to be given will show. Considerable alarm prevailed, and the subject was again presented to the consideration of the Legislature. The Special Commit- tee to whom it was referred, made a long report, (Sen- ate Document, 1840, No. 5.) It is devoted principally to the efficacy of vaccination, as a preventive of the disease, and states many reliable facts, though some of 8 SMALL POX. [April, the inferences from these facts do not always seem justly warranted. On their recommendation the 43d and 44th chapters of the Revised Statutes, requiring householders and physicians to notify the proper au- thorities of all cases of the small-pox coming to their knowledge, was re-enacted. This act, however, was entirely inoperative, and in 1848 another act was passed removing all restrictions in regard to the disease. The following statement, showing the number of deaths by small-pox, in Boston, each year, for the last forty-five years, will illustrate the effects of the differ- ent legislation, and other sanitary measures, in opera- tion during that period:- Year. Deaths. Year. Deaths. Year. Deaths. 1811 2 1826 0 1841 57 1812 0 1827 3 1842 42 1813 0 1828 2 1843 55 1814 0 1829 0 1844 0 1815 5 1830 1 1845 31 1816 0 1831 4 1846 92 1817 0 1832 2 1847 23 1818 0 1833 0 1848 21 1819 0 1834 4 1849 21 1820 0 1835 7 1850 192 1821 0 1836 6 1851 63 1822 0 1837 13 1852 12 1823 0 1838 3 1853 6 1824 1 1839 60 1854 118 1825 1 1840 115 1855 186 1856.] CITY DOCUMENT, No. 30. 9 This is an important and extraordinary statement of facts. It appears that during the last twenty years, one only (1844) occurred in which there were no deaths by the small-pox, and that during that time eleven hundred and sixteen deaths took place. -While during the previous twenty-five years there were fourteen years in which there were no deaths, and that the whole number of deaths during that period was twenty only. It is the opinion of intelligent physicians, that, under the exist- ing modes of treatment, the proportion of deaths to the total number of cases of small-pox cannot be fairly estimated, on the average, at more than two per cent., or one death to every fifty cases. By multiplying the number of fatal cases by fifty, we obtain the whole estimated number of cases. On this basis it appears that for the last twenty years (1116 + 50)=55,800 cases have occurred in this City ; for the last ten years (734 + 50)=36,700 cases; and for the last five years (385 + 50)-19,250 cases. Last year there were one hundred eighty-six deaths, (186 + 50)=9,300 cases. If this subject is examined in a pecuniary point of view only, it will suggest strong reasons for the adop- tion of some remedial measures. It has been supposed that each patient will require, on the average, the attendance of a physician twenty-five days, and must have household accommodation, medicine, nursing, and be deprived of income from labor. On this basis the pecuniary loss to the City by the small-pox, during the five years, ending December 31, 1855, may be fairly estimated according to the subjoined statement. Each case may incur- 10 SMALL POX. [April, Medical attendance, 25 visits at $1, . . $25. Board, household accommodations, medicine, nursing, &c., ..... 25. Loss of income from labor, ... 12. Total estimated cost of each case, $62. 19,250 cases, at $62 each, gives . $1,193,500. The additional cost of paupers made such by the loss of relatives, maybe . 106,500. Loss to the City for the last five years, $1,300,000. Or for each year, on the average, . 260,000. For the Last year alone, it was (9,300 -}- 62,) 566,600. This is indeed a great loss ; but who can estimate human suffering, loss of life, and all their attendant train of evils by dollars and cents. It shows, however, that the presence of the small-pox among us is a great evil, pecuniary as well as physical and moral, and calls forcibly upon the public authorities for its mitigation. Is there an effectual remedy which can be applied for the removal of this great evil ? In the judgment of the undersigned there is; and that remedy is com- pulsory vaccination. The City has already provided that no un vaccinated child shall be admitted into the public schools; and for the class of persons interested it is a most excellent regulation. It has also provided for the gratuitous vaccination of such persons as may apply to the City Physician for that purpose. This regulation is also to be commended ; but it does not fully meet the public want. Experience has shown, contrary to the opinion of the petitioners for the repeal of the Revised Statutes in 1837, that even the presence 1856.] CITY DOCUMENT-No. 30. 11 of the disease in the City will not induce the inhabi- tants generally, to protect themselves against it by vac- cination, so indifferent is man to the preservation of his own health and life, and thousands upon thousands remain constantly liable to the disease, and will become its victims when exposed. There is, too, still existing some prejudice against vaccination. Some disbelieve in its efficacy, and some think it may aggravate the evil by "tempting Providence." What is now needed is a general vaccination of the inhabitants, by house-to-house visitations, enforced by the authority of the City; and this might be done some- what upon the following plan:- Each Ward of the City might be divided into eight or more districts, to each of which should be assigned a com- petent physician, who should be required to visit each house and each family, and to examine and vaccinate, and to revaccinate if deemed expedient, every person. A blank book constructed upon a proper plan for regis- tering the name, age, date of vaccination, and, whether it was for the first, the second or other time, the results and other desirable particulars, should be kept. Per- sons examined but not re-vaccinated should also be noted. Let this plan be carried out thoroughly as it might be, and the disease would in a short time be ex- pelled from the City, unless introduced afresh from abroad which very seldom happens. The unvacci- nated coming into the City from other places do not bring the disease with them but take it here. Such a measure, beside the security it would give the citizens, would afford a large amount of information which might be made of practical utility. 12 SMALL POX. [April, In estimating the expense of this labor, it may be stated, that competent physicians might probably be obtained to vaccinate so great a number at one eighth of a dollar each. Of the whole number of inhabitants of the City, estimated at 160,000, it is probable that not more than one half, or 80,000, would require vac- cination. These would cost, on this estimate, $10,000 only. But suppose it amount to double of that sum, it would still be little more than is expended annually for a Fourth of July celebration, or for many other matters of no utility when compared to this. It would be an expenditure which every good citizen would ap- prove, for the great amount of good which it would accomplish. Facts and arguments might be further extended in favor of the adoption, by the City, of some efficient measure for relief from the evils under which it has so long suffered; but this simple statement, will, it is be- lieved, be sufficient to call the serious attention of your honorable Board to the subject. It has been said by the Registrar General of England, in relation to the cholera, that, it " is a Health Inspector that speaks in language which nobody can misunderstand; it visits the prisoner in the hulk on the polluted river, the neg- lected lunatic in his cell, the crowded work-house, the establishments for pauper children, the sides of stag- nant sewers, the undrained city, the uncleansed street, the cellar and the attic; as well as the fair open quarters which strangers frequent and admire. The oversights, the errors, the crimes of persons, who in responsible offices have charge of the health and life of men, are proclaimed aloud by its inexorable voice." 1856.] CITY DOCUMENT-No. 30. 13 If such language might properly be used in relation to a disease to which sanitary measures can be applied only with uncertain results, with how much greater force may it be used in relation to one, to which meas- ures may be applied known to be efficient. That the subject may receive that attention which its importance demands, is the earnest prayer of the undersigned. He desires also to call the attention of your honorable Board to the consideration of the sug- gestions under the Sth Recommendation of his Sanitary Report, already referred to, (p. 115), relating to the establishment of a Board of Health in Boston. LEMUEL SHATTUCK. Boston, March 31, 1856.