July 15, 2015

Smallpox: Vaccination not Quarantine

By Natasha Hollenbach, Montana Digital Newspaper Project Assistant

On Nov. 25, 1909, The Whitefish Pilot (below right) ran the headline “Quarantine Abolished.”  Further reading reveals that beginning January 1, 1910, people with smallpox were no longer to be confined to their homes or the ‘pest house’ (a term used for an isolation house where contagious patients were sent to contain the outbreak).  While these individuals were still prohibited from public transit, this change in regulations defied the long established procedure of isolation and containment.  The motivation for this change seems to have been to encourage vaccination.


Although the first vaccination for smallpox was created in the 1790s, smallpox outbreaks remained common.  Outbreaks in Butte (1883), Missoula (1885), Anaconda (1893), Great Falls (1899) and Missoula & Butte (1900) showed that the problem was real and needed to be met with consistent, coordinated action.  Disease doesn’t stop at city or county lines, and neither should the response.  In addition, some authority was required to issue the sometimes unpopular orders to ensure a quick, effective response. 

In 1901, the Montana State Board of Health was created, and one of their first acts was to require children to be vaccinated before attending school.  Smallpox outbreaks continued, though the number of infected children plummeted.

From January through March 1905, there was an outbreak in Billings.  Although Billings officials were praised for their quick reaction, one-hundred fifty-eight cases were reported, of whom 16 died.  By mid-March, discussion of the epidemic in the Billings Herald revolved around money, for good reason, since it reportedly cost Billings over $25,000.  During the Billings outbreak, officials took several measures.  Everyone exposed was vaccinated.  Those who were showing symptoms went to the pest house, and those who didn’t were sent to a detention house for observation.  Every physician in town was employed by the city to either care for patients or to form diagnosing squads who investigated possible new cases.  The police force was enlarged to enforce the quarantine.  Vaccinations were wide spread: in a town of about 6,000 over 4,500 tubes of vaccine were purchased, and presumably used, during the month of January.


There was of course opposition to these measures.  Objections had two main threads: costs and the perceived violation of personal liberty.  The issue of cost had been debated for years.  Although most people either didn’t know, or didn’t believe, it actually cost taxpayers significantly less to provide free vaccinations than it did to treat those infected.  Those who objected for personal liberty reasons were generally “anti-vaccinationists” who didn’t believe in the effectiveness of vaccinations.  However, in February 1905 the Supreme Court case of Jacobson v. Massachusetts supported mandatory smallpox vaccination programs in order to protect public health.
Thomas Tuttle, M.D.,
Executive Officer State Board of Health,
 1903-1912.
MHS Photo Archives PAc 96-1.2
Following the outbreak, T.D. Tuttle, Secretary of the Montana State Board of Health, wrote a circular entitled “Small Pox, Its Prevention, Restriction and Suppression.”  In it, he emphasizes the importance of vaccination and promotes the same reasoning used in the 1909 Whitefish newspaper article.
“It is the firm belief of the author that the most effectual way to rid this country of small-pox would be to give a few months warning, in order that all might have time to be successfully vaccinated, and then let any cases of small-pox that might appear go at large, without disinfection, so that those who would not be vaccinated might have the disease and be done with it. Such a move would result in a radical “change of heart” on the part of many, if not all, “anti-vaccinationists.”
In 1909, Tuttle’s recommendations were enacted.  However, while quarantines were no longer required, local and county boards of health still had the authority to declare quarantines within their jurisdiction, which lead to some cities, like Missoula, continuing to use quarantines.  The River Press of Fort Benton, on March 15, 1911, reported that there had only been two deaths from smallpox during the previous year, which shows that whichever way the local boards decided, smallpox seemed to be under control.
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Sources:

Billings Gazette, March 10, 1905, March 21, 1905, March 24, 1905, and October 31, 1905.

The Daily Missoulian, December 3, 1909, December 31, 1909.

Leahy, E. (2000).  Active ingredient: Smallpox: genesis of the Montana State Board of Health.  (MHS catalog call number: 614.5 L471A)

The Montana State Board of Health (1905).  Small Pox, Its Prevention Restriction and Suppression.  (MHS catalog call number: S 614.5 H34SP)

The Montana State Board of Health (1953).  50-year history: Montana State Board of Health, 1901-1951. (MHS catalog call number: S 614.09786 M762FYH)

Photo – Smallpox vaccination site Days 4 through 21. http://emergency.cdc.gov/agent/smallpox/vaccination/facts.asp

The River Press, March 15, 1911.

Whitefish Pilot, November 25, 1909.

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