OD LA D HI TORY · lum] would correct within its restricted domain °Mr.Jacobi., a lTadua,~of Brown Un,v,""y."a S,ucknl a, Cor n~lI ""'wSchool. by FredJacobs 0 the faults of the communityand

OD LA D HI TORY

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1

RI1G~

Th .. ron~lI11crion of BUll.., Hc.pll. 1( J84 7) . nd Rhod.. I"J;lUd H os pir,,/ (,00"", 11168) m.rkM Ih" lld~nfof in'!lfUriomlizM mNDe-in..in Rhod.. I./.nd.

I

RHOD E ISLAND HISTORY

Publ.i&h~byT HE RHODE ISLAND HISTORICAL SOCIETY. S2 POWE RSTREET. P RO VIDENCE. RH ODE ISLAND 02906MId print":!by .. (rani of thlt STATE OF RHODE ISLAND ANDP ROVIDE NCE PLANT AnONS. J- Jc-ph Garrahy. GovHnOr.

Dennis E . Stark. pr~identRobert 1- McKenna, vice pr~identRobert B Lyn ch . vice prnidentRichard F . Staples , s~rerary

Ra chel Cunha. assistant secrers ryKarl F . Ericson. treasurerStephen C. Williams. assistant treasurerAlbert T . Klybe rg. directorClifford P. Monahan. director emeritus

Issued Quanerly at Provide nce . Rhode Island.February. Ma y. Au gust. and Novem ber. Secondclass postage paid at Provid ence. Rhode Is land .

Editorial offices at Aldrich House. 110Benevolent Street. P roviden ce. Rhode Island02906

TA BLE or CO:\'TENTS

Isaac Ray and th eProfession of Psychiatryby Fred Jacobs 99

FELLOWS OF THE SOCIETY

Carl BridenbaughSydney V.JamesAn toinett e F . Downing

Smallpox Vaccination :A Leap of Fa ithby Joan Retsinas

Index

113

125PUBLICATIONS COMMITTEE

E. And rew Mowbr ay, chairmanHenry L. P . Beckwit h, Jr.F rancis H. Chafee. M.D.Pat rick T. ConleyWen dell D. GarnettSeeberr J.Goldowsky, M. D.Robert Al len GreeneCharles P . O 'DonnellNorm an W. Smith

VOLU M E 38 NUMBER 4 NOVEMBER 1979

RHODE ISLAND HI STORY (ISSN 0035-4(19)

The Rhode Island Historical Society assumes noresponsibility for the opinions of contributors.

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STAF F

Glenn Warren LaFantasie. t'dirorHelen Kebabian, picture editorSarah C. Gleason. editorial apprenticeGlenn D. Horton . editorial apprenrice

Rhotk [ .J. nd Hdfory(I94 2· ) an d iu prO'dKeMOn Rhotk IslandHr.toric. 1SocJrry Co!ltniom (19 18-1941) and Publication. 01 rh..Rhod.- hand H.,oricM 5oci..ty (l893-- I901) ate avaibbl.. in microform from XIOt'OX Un;vO'rlity Microfi l.-. 300 North Zft'b Road,Ann Arbor. Michil an 48106. (313) 761<4700. Ple.... writ .. for c0m

pl et e in fonnalion. AnKles app.-arinl in this joumaJ ate at.traetedand indeJled in H isroric.J Abnr«ts and Amtmc..· H islory and L.i/...

99

Isaac Ray and theProfession of Psychiatry

When Dr. Isaac Ray left Maine in 1845 to becomethe first superintendent of Rhode Island's ButlerHospita l. he promised to stay only three or fouryea rs . Ray. a spec ialist in the tr eat ment of mentalillness. remained at But ler until 1869. During histwenty-four year tenure, he decisively shaped notonly the hospital's development. but also the Iulure of the ca re of the mentally ill in Rhode Is land. At the outset. he promoted a vision ofuniversal hospital care for all of the deranged.and made Butler a model of private philanthropy.By the t ime he left in 1869, Ray encouraged whatwas already hecoming a reality throughout theUnited States: a segregated system of ins titu tional care in which wealthy or curable patients wouldbe the beneficiaries of institutions such as Butler.while the poor and incurable would be relegatedto large publi c facilities. A study of his impressiveand influential career reveals much about the nature of mid-nineteenth century medical practice.

Ray's prominent role in determining howR hode Island provided for its deranged cit izenshas received little attention. Som e historians havestr essed Ray's signi fica nce as a spo kes man fornine teent h-century Am erican psych iat rists. butthey have neglected to examine closely his actualpractice of the mental science.I David Rothman.for example. relies heavily on Ray's writt en worksand suggests that Ray and his colleagues hopedthat the ordered world of the mental hospitalwould halt the changes that were taking place inJacksonian America . Accordin g to Rothman. theybelieved that "the new world of the insane [asylum ] would correct within its rest ricted domain

°Mr. Jacobi., a lTadua,~ of Brown Un,v,""y." a S,ucknl a, Corn~lI ""'w School .

by Fred Jacobs 0

the faults of the community and through the power of example spa rk a general reform movem erit."!

Ray's ideas. ho wever. should be evaluated inlig ht of h is work as superintendent o f Butler Hospital. Such a perspective indica tes that his program at Butler did not correspond in any simplefashion to his perceptions of social decay. Ratherthan desiring to reform or reconstruct societythrough the example of the asylum. as Roth manmaintains. Ray sought more modestly to establishthe place of h is medical specialty in American s0

cie ty. This sense of professionalism - the claimthat one possesses specia l learning and expert ise.and is therefore entitled to excl usive and autonomous practice in a pa rt icular field - was the primary motivation throughout Ray's long career.'

Ray's unyielding pursuit of the physicians'right to be exclusive guardians of the insanegreatly affected the quality of care that Rhode Island's mentally ill received. Hi s initial campaign- wh ich lasted from 1845 to 1855 - to providehospita l care for all of the st at e's deranged promised to supplant the vagarie s of local provision sfor the insane. The regimen of moral treatmenthe ins tituted at Butler. whereby the dera ng edwould receive humane. intensive therapy. also offered the hope of recovery to some of the afflict0<1.

By 1860. Ray was promoting a very differentvision of the mission o f a mental hospita l. Whenhordes of fore igners flocked to American shoresa t m id-century. Ra y and others recoiled in xenoph obic horror. Accordin g to Ray. moral trea t-

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100 ISAAC RAY

merit worked well for the na ti ve-born population.but no t at all for Iri sh an d German immigrants.As a resu lt, he ini tia ted an admissions policy atButl er that had the effect of excludin g foreigners.Clinging to his vision of asylum care for all of theinsane, however, Ray also espoused a segregatedsystem of mental ins tit utions: sma ll. private hospitals like Butler wou ld serve the presumably curab le pa t ients. while larg e public facilities offeringcustod ial con finement wou ld meet the needs ofthe allegedly incurable, many of whom happenedto be foreign born. When the State Asylum forthe In curable Insane opened in 1870 on the formerHoward farm in Cranston, the State of Rhode Island joined New York and Massachusetts inadopting such a system of dual hospi tal care.

Born in 1807, Ray brought to his profession thecu rious blend of stol id conservati ve and anxiousreformer attitudes that characterized many of thepion eers of American psych iatry." Ray was ra isedin Beverly, Massachusetts, a small maritime villag e twenty-five mil es no rt h o f Boston . After prepa ratory school at Phillips Academy, he leftMassachusetts at the a ge of fifteen to attendBowdoin College in Maine. Bowdoin during the18Ws o ffered an in vigo rati ng environment tosuch students as Henry Wordsworth Longfellow,Nathan iel Hawthorne, and Luther Bell , who laterdesigned Butler Hospital. '

Illness forced a temporary departure fromBowdoin, and Ray returned to Beverly in 1824.While at home, he began to study medicine wit h alocal physician. Dr. Samuel Hart. Ray's searchingmind was not content with the lessons of a sma lltown pra ctitioner: wit hin the year, Ray mov ed toBoston, where he resumed his medical studies under Dr. George Cheyne Shattuck , second in a longfam ily line of prominent Boston physicians.e

Shattuck preached conservative medicine. Inan age when qua ckery and promises of instantcure dominated the healing arts, Shattuck warnedRay o f the uncertaint ies of medical science. Ray'smedical dissertation , com pleted at Bowdoin in1827, reflected Shattuck 's lessons. In his "Remarks on pathologi cal anatomy: ' Ray inveigheda gainst popular notions of vitalism, a theory thatabjured physiological explanations of life pro-

cesses in favor of mystical ones. Instead, Ray ex pressed a st rong faith in biological descriptions ofpathology.'

"At the tender age of twenty: ' Ray wrote in1855, "being a member of the medical professionin regular standing, I offered my servi ces as pra ctitioner of med icine and surgery to the people ofPortland [Maine] in 1827. They manifested no vehement des ire to avail themselves of this privilege.w Tc Ray, the moral of his inability to findemployment was clear: the success of a physiciandepended not only on fine ly honed professionalskills. but also on an accepting public.

Perhaps to salve his wounded pride. Ray leftAm erica and t raveled to Europe. Before long, hewas rus hing about Paris. attending medicalleetu res a nd scribbli ng entries into his diary. European doctors stood at the forefr ont of medicalresearch and practice, and Ray obse rved the lat est advances in surgery and hospital care."

Ray returned to Maine in 1829, but decided notto try his luck again in Portland. Instead, he estabJished a general practice in rural Eastport.where the lesse r demands of a small town left himfree to read the writings of the Europeans. Whileministering to the citize ns of Eastport between1829 and 1841, Ray supplemented his formal education by reading the works of European phrenologists 1- G. Spcreheim. Franz 1- Gall andGeorge Combe, as well as the treatises on moraltreatment written by Phillipe Pinel. WilliamTuke, and Jean Etienne Dominique Esqui rol."Such works influenced Ra y's de cision to becomedeeply involved in the care of the insane. H ischoice of a specialization can be understood onlyin the context of early nineteent h-century developments in E uropean and American medicine.

Pinel's dramatic demonstration in Salpetrierethat methods of moral treatment -Ii\ndness, humanity, and gentle persuasion - proved far moreeffective in the care of the insane than seclusionand bondage. and struck at the core of what hadheretofore been an exclusively medical enterprise.'! Reacting against the well-documentedabuses in medically managed hosp itals for the insane. proponents of moral treatment establishedtheir own institutions in which physicians playeda clearly subordinate role. William Tuke and hisson Samuel founded the York Retreat in Englandwith financial assistance from the Quaker commu-

101 ISAAC RAY

nity. Frankly antagonistic to the designs of medical men, the younger Tuke reponed in 1813 that"the experience of the retreat ... will not addmuch to the honor or extent of medical science. Iregret ... to relate the pharmaceutical meanswhich have failed rather than to record thosewhich have succeeded.':"

Confronted by a treatment which producedmore cures and fewer abuses than their own ministrations, English doctors resisted the morallymanaged institutions. Yet if they hoped to remainactive in the care of the insane, these physicianscould not ignore the superior performance of thenew facilities. Their plight became urgent: a series of exposes in England on conditions in medically run private hospitals further discredited suchestablishments, while the publication of Tuke's"Description of the Retreat" in 1813 brought national acclaim to York. A reconciliation of moraland medical means remained the only salvationfor English doctors if they hoped to continuetreating the mentally ill. To achieve the uncertainsynthesis. such men depended on the phrenological theories of Spurzheim and Gall.'!

Moral reformers, more interested in resultsthan in theories, paid little heed to discovering anetiology of insanity. Anxious to bring moral treatment within the purview of their profession, physicians searched for an adequate scientificexplanation of the origins of mental disturbances.They formulated a "Cartesian dualism" betweenmind and body that explained derangement as adisease of the nervous system, rather than of theunderstanding. The view that the brain. acting asthe material instrument of the mind. could be-come diseased at once avoided the heresy of contradicting the Christian belief in an immortalsoul, and provided "proof" that insanity was indeed an organic dysfunction. Formerly explainedas a defect of the soul. bizarre or outlandish behavior could be comprehended in phrenologicaltheory as a result of an organic imperfection ofthe brain. Yet the treatment Spurzheim proposedhardly differed from the techniques applied by themoral managers. In their early stages. he maintained, such maladies could be cured by adheringto a regimen of "fresh air, physical exercise, blanddiet with no liquor or tobacco. plenty of rest andsleep and moral uplift, warmth, placidity, and little intellectual effort."!'

In America, Isaac Ray reasserted the synthesisof moral treatment and medical etiology that hadbeen forged by English physicians. The book inwhich he accomplished this feat . A Treatise onthe Medical jurisprudence of Insanity, first appeared in 1838. Since that time, it has receivedmuch attention as a pioneer study of the legal aspects of mental disease.IS In terms of Ray's career,Medical jurisprudence proved especially important as the reason for his decision to leave Eastport and undertake duties as the head of theMaine Insane Hospital . With the publication ofMedical jurisprudence. Ray began his life-longquest to make the care of the insane an exclusively medical enterprise.

Early ninereeruh-century American reforms inthe care of the insane paralleled European developments. Prior to 1800, those few American doctors who concerned themselves with the mentallyderanged relied heavily on the techniques of classical medicine. But such "heroic" therapies. inwhich patients were bled or otherwise purged. didlittle to restore the sanity of disturbed individuals.though such depletions might have calmed eventhe most violent maniac." As in Europe, reformof such medical practices fell therefore into thehands of lay practitioners.

Pennsylvania's Quakers. familiar with Tuke'sexperiments in moral management. adopted similar techniques at the Friend's Asylum, founded in1810. Like Tuke, the American Quakers reactedagainst prevailing medical therapies. Boston'sMcLean Asylum, opened in 1811, and the Connecticut Retreat in Hanford, founded in 1815, employed doctors in the top positions, but neither ofthe men in charge paid attention to medical matters. Though they rejected heroic therapies in favor of moral means. Rufus Wyman at McLeanand Eli Todd at the Retreat expressed no interestin providing the theoretical reconciliation of theirprofessional training with the new mode of treatment. By 1820, then, the care of the mentally illcould not be considered a growth industry forAmerican physicians. "It appeared to many," observes historian Norman Dain, "that the only requirements for practicing moral care of the insanewere human sympathy and common sense, attributes not confined to the medical profession.':"

Discouraged but not defeated, American doctors, like their English counterparts, fought vi-

102 ISAAC RAY

go rously to win complete control of the care ofthe insane. Ray's M edical Jurisprudence was amajor weapon in the fight. In it, Ray unhesitatingly articulated the rationale for the treatmentof the insane exclusively by trained physicians. Asdiagnostician and minister of appropriate remedies , the medical specialist o ffered - in Ray's asse-ssment - unique and indispensable services.

Foremost in Ray's mind, and crucial to the professional defense. was the notion that the deranged individual suffered from an organiccondition hardly differ ent from any other physiological dys func ion. "No pathological fact is betterestablished," he wrote assuredly, "than that deviations from the healthy st ructure are generallypresent in th e brain s of insane subjects.':" Despitethe limitation tha t such pathological changescou ld not be readily identified an d corrected. Rayspoke confidently, if somewhat de fensively, ofmedicine's unassailable rig ht to the exclusive careo f those a fflicted with madness: "To distin guishthe manifestations of health from those of diseaserequires the exercise of speciallearning andjudgement: and if no one doubts this propositionwhen stated in reference to the bowels. the lungs,etc.. why should it be doubted when predicated ofthe brain?"ll

Phrenological theories provided both a physiological explanation of insanity and a prog ram oftreatment. and suggested to Ray. just as they didto Eng lish physicians, the need ed link betweenthe uncertain patholo gical origins of madness andthe use of moral therap y. If "the human brain isdirectly affected by bodily health," as Ray and thephr enologists maintained. th en th e derangedmind could be cured by adhering to a regimen ofexe rcise . proper diet. sufficient sleep and relaxation.w T he need for med ical trai ning was thusminimized .

Ray did not limit his study to the treatment ofinsanity. H~ believed that court proceedings affecting the insane, no less than the rapeutic decision s. should be the special province of themedical witness. possessing "extraordinaryknow led ge an d skill rela tive to the particula r disease, insanity." The judicial system of Ray 's timeexcused crimes by reason of insanity only whenthe defense could prove that an accused individualretained "not the slightest vestige of rationality."Ray he ld that this one-hundred-y ear-old dict um

failed to take into account the knowledge accum ulated by experts in the treatment of mental diseases. Close observations of the insane by medicalmen revealed that the disease went through various phases. some involving a complete loss of rationality. others so mild as to seem to theuntrained eye a sure sign of normality. Only thecounsel of an expert medical witness, Ray maintained, could distinguish feigned from genuine insanity."

T hree years after the publication of Medical Jurisprudence, Ray left his general practice to assume the superintendency of the Maine In saneHosp ital, a public facility tha t had bee n foundedin 1840.:l His decision mark ed the beginning o f adistin guished career in which he ma nifested an almost missionary zea l in matters of insa nity. YetRay's ardor and pe rtinacity reflected less an "enligh tenment" faith in man's perfectability or therespon se o f an outraged h uman itarian to the mistreatment o f the insane than it did a quest tomake the care of the men ta lly de ra nged an exclusively medical enterprise. Ray did not make laboratory discoveries that placed the treatment ofinsanity on firm er biological grounds: rather, likehis E nglish counterparts, he sought to prove thatmedically trained specialists. not lay reformers.were bes t suit ed to pract ice moral treatment ofthe deranged.

Ray's profess ional frustration as the superintendent o f the Maine Insa ne Hospital quickly became evident. how ever. Above all, hisdissatisfact ion reflect ed the const raints of a publicpos ition . Ray's performance as superintendent received legislative scrutiny, and in one ins tance,publi c ridicule. The Maine Hospi tal's design offered none of the st ructural accou t rem ents h ethou ght so vita l to the proper care of the insane."To state all of the fau lts of Worcester H osp ital"and other public inst itut ions. Ray observed in1844. "would require a volume:' By 1845. he welcomed a change. When the trustees of the newlycreated Butler Hospital in Rhode Island offe redRay the superintendency in January of that yea r.he eagerly acc epted."

For a conce rned professional like Ray. the Butler position seemed ideal. Here he had an opportunity to contribute to the Butler design. so that thefinal product might demonstrate the preemin enceo f medical specialists in all facets of the ca re of

l

103 ISAAC RAY

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f :" gravi"l: or 8ull~r Hospital.

the insane. As an employee of private philanthropists. he would be free from the watchful eye ofstate government. He would be at the helm of aninstitution where financial support came from indiv iduals whose education and bac kgroun d resembled h is own, and wh o ha d a st rong faith in hisspecialty."

Arrivin g in Rhode Island. Ray proposed onlyslight modifications in the plan for Butler whichhad been submitted by Luther Bell, Ray's classmate at Bowdoin and the superintendent ofMcLean Hospita l in Boston." Like Ray. Bell hadlittle respect for Am erican hospital design. "T heconstruction of insane hos pitals in this country isst ill quite in its in fancy . ... There are for ms ofconstruction Iar better than we have: ' he observed in 1844. Instead. Bell looked to Europe formore suitable examples of hospital design. andsubmitted what he called an "ideal plan" for Butle r, based en the precedents of E nglish and Scot-

tish institutions."Perched above the Seekonk River. Butler's

main building was set amidst J13 acres of woodedhills. open fields. and dramatic vistas. Two-hundred eig hty feet lon g. the Ecsh aped structure alsoincluded tw o wings. each 145 fee t lon g and twostories high . as well as a sh ort er central projectioncontaining facilities for heating. cooking. andlaundry. Decorative masonry and other embellishments adorned the exterior o f the hospital, reFleering the bel ief that an asylym for the insane.no less than a church or a state ca pital. should bea work of orn amenta l as we ll as practical design."

T o the practi tione rs of moral t reatment, a sa lubrious physical environment contributed signifi·cantly to the mental well-being of the patients.Med ica l therapies had less to do with recoverythan clean air, commodious apartments, and comfortable furnishings. Thus, Butler included no facilities for medical surgery or laboratory wor k.

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104 IS......C R...Y

Though ea ch ward contained a "bathing room"with facilities to treat the most seri ous paroxysmsof the deran ged , the curative mechanisms of thehospital could be found in apparently non-medicalfeatures. For Ray and Bell, the achievement ofth e medical profession would be to design a hospital whi ch proved far supe rior to the mo rally managed institutions founded by laymen like Tukeand the Pennsylvania Friends."

The hospital created an ambience that Rayhoped was conducive to improvement of the mentall y ill through other structural provisions. Instead of the low, narrow, dimly-lit corridors socha ract erist ic of public inst it ut ions of the time,Butler incorporated "galleries" for patient quarters. On e side of each hallway contained staff andpatients' rooms, while the open windows of theopposite side provided illumination and a pleasantview.llI Each hallway contained common roomsfor recreation , whil e attendants' quarters werecarefully placed to afford a view of the patientswithout constant and obtrusive surveillance.

For the viole ntly insane, Ray and Bell strove toprovide secure, yet humane facilities. Decorativeiron grates performed the functions of windowbars, but av oided the appearan ce of a jail. Built-infurniture guaranteed security but mitigated thesterility of a barren room, while the violent patients could in their quieter moments enjoy unrestrained freedom in an adjacent hall .w

But ler contained three other types of accomodations. For paupers, there were four do rmitories,each with room for six patients , More affluent clients could choose a private room with all the furnish ings of a domestic chamber. The wealthiestindividuals might choose one of twelve two-roomsuites. In addition to the twenty-four beds for pa upers, Butler contained eighty-four single sleepingrooms, giving the hospital a total capacity of 108patients, with room for an estimated thirty morein the unfinished th ird DOOLl l

The hospital came close to matching Ray'shigh expectations. The poor, he wrote, would "beprovided for in a manner equal to that of our bestState institutions, while the rich would receivesometh ing like an equivalent for any compensation they might be required to make: ' Ray delivered a warm encomium on the completedstructure, "T he diffe rent divisions of the edificeare tastefully grouped together in Tudor-Gothic

style ," he approvingly observed. "while the various bold projections give Butler an air of ret irement and repose exceedingly appropriate to thecharacter of the establishment.':"

Butler's success depended in large measure onthe publi c's favorable reception; Ray and thetrustees had to present a convincing argument forthe ad vantages of hospital treatment ove r moreeconomical provisions in homes or local poorho uses and jails. A medical etiology of insanitymight h ave convinced Ray and his colleagues ofthe importance of specialized asylums for the deran ged, but how could these pro fessionals justifythe need for such care to a cost-conscious, oftenskeptical publi c?

The advantages of hospital over home care,Ray argued, were those of degree rather than ofkind. "Very much of the advantage possessed byhospitals over pr ivate families," he had written in1844, "consists in the greater fidelit y with whi chthis kind of t reatment can be pursued." In fact , according to Ray, the ch aotic home life of manyfamilies contributed to the increase in mental pathology. Only the jud icious ministrations of theexperienced hospital superintendent cou ld minimize the effect of such disturbances by secludingafflicted individuals "from whatever tends to produce excessive emotions," The trustees concurredin Ray's evaluation , declaring in their "Remarks"of 1847 that those possessing "any knowledge ofthe subject" would readily acknowledge that theinsane would be better off in "esta blish ments designed expressly for the purpose than in privatefamilies: ' Mo ral means, far more important tocuring mental disease than medical ones, "are obtained only in the greatest perfection in public establishments.?"

The m ental hospital also surpassed ~oca l pro visions for the incurably insane. Accordin g to thet rustees, the spacious and comfortable ha lls of theasy lum gave rel ief to those who would otherwisebe "confined in cages, or narrow rooms, badlylighted, warmed and ventilated, where they spendthe wretched remnant of their days, deprived ofevery alleviation of their misery: ' Considerationsof publi c safety also made the confinement ofsuch individuals necessary; if the deranged had tobe rest rained, the specializ ed asylum offered theonly humane way to ach ieve this purpose. "T hesafety of society requires , , , that this class of per-

105 ISAA C RAY

PLA~ or DIITLER HOSPIT ..... L.JNr/~.r .1# Itrl t. fA~ mrA

Bu,l.,'. mno"",u "~ p/vI w.u f1ItN~hNin rll. hwprl.lJ'• .InnlUl report 0/11U9.1nd wil h ,In .ITT;Cl~ ,n rll. Ammcan jounu.l of IllI.I n ·"Y_

sons should have their abode where they will bedeprived of no necessary comfort. and allowedmany which they scarcely knew before," the trustees concluded."

Rhode Island in the 1840s seem ed - on the surface - rece pt ive to the arguments made by Rayand the trustees. In 1847, the General Assemblyauthorized the towns to send any "lunatic or per·son furiously mad" as we ll as insane pa upers toButler Hos puat.» Local newspapers urged thetowns to heed the legislature's recommendation.citing the litany of horrifying abuses found in I~

cal asylums, poorhouses, and wor khouses thatDorothea Dix and others had exposed. The Newport M ercury noted that "few persons are awareof the sufferings that have bee n endured by thisaf flicted class of people. Others remain in townasylums where they seem doomed hopelessly to

Il:7" References to the Plan.A. A.~plion rooms; B. Doctor's offiee : C. Sum, nI'. uf

fice; D. D. Common Plrlors for patient. oec-up}'ing front galleriN ; E. Halls for r-ti<'ntt; F. Roomt in which patientt-.e theirfriends; G. Dining room; H. Priq te parion : I. Sleeping rooml;K. Atteodanl' s room!: L. Associated dormilOries ; :\1. Water·dlJ8etl ; No Bathing rooms; O. Wu h roomI; P. Domestics' Din

ing room, {the door into lhe entry is accidentally omitted]; Q.'Ilitron', ston' r'" llll ; R. Kill'h,'n ; ~. lronin :::: and Drvin~ room:T . Stu", room.

IIIHSUO'....

perish, without an effon being made for th eir restoration by their fellow men.">

The vision of hospital care for th e insane espoused by Ray and the trustees did not at first appeal to all Rhode Islanders. By December 1, 1847,the hospital received only a small fraction of thestate's insane. Ray lamented in his first reportthat "only four towns in the state have assumed inany degree, the maintenance of thei r insane poorin the hospi tal ," After two month s. the hospital

106 ISAAC RAY

was less than half full. The meager response pe rplexed Butler's trustees. They had set $2.25 as theminimum weekly rate, 25c less than the charge atWor cester Hospital. but most towns in the stateseemed unwilling to avail themselves of this apparent bargain rate. For the towns, it did notmake sense to place their insane poor at Butler;the annual COSt of keeping a pauper in a local asylum or poorhouse was less than half the yearlycharge at Butler. "T h e present number of patients: ' the trustees warned, "is not sufficient todefray the expenses of the hospita l." By Jan ua ry1,1849. the hosp ital ha d accumulated a deficit of$4,016, nea rly one-t hird o f the yea r's total expenditure of $14,467.J1

Initial fears proved to be unfounded. By the endo f 1849, Ray reported that patients occupied 107of the 108 beds at Butl er, and wrote happily that"the number o f those who sought the benefits ofthe hos pital is greater than cou ld be reasona blyexpected.t'w Yet the towns seemed to be sendingonly their most un ruly patients to Butler. an dRay. ever the concerned professional, remainedunsatisfied with the state's self-serving reception.

Ray's uneasiness reflected his belief that thesuccess of the mental hospital still depended onvoluntary expressions of public faith . "In commonwith other institutions of a similar kind." he observed in 1849, "our appropriate duties a re performed rather by sufferance of public sentimentthan any sanction of law, and thus we live consta ntly at the mercy of excited passion an d prejudice ."> No Jacksoni an, Ray evinced little faith inthe good sense of the "people." He had experienced first hand the whimsical na ture of popul aropinion in 1827, when he cou ld find no work as agenera l practition er in Portl and. Such opinionseemed in certain respects to favor Butler Hospita l in 1850, but might it not at any momen t turnagainst the hosp ita l's purposes ? Ray's mission remained unfinished until soc iety and gov ern mentrecogn ized - through statutes and administra tiveprocedures - his vision of the specialized hos pita las the exclusive asylum for all of the insane.

Ray and the trustees fought vigorous ly between 1849 and 1852 to establish Butler Hospitalas th e ap propriate institution for the state's deran ged. In their campaign, they stressed theunique services provi ded by such asylums. the absence o f h umane alternatives, and the need for

legisla t ion that recognised the importance of hospitalization of the deranged.

The trustees noted especially the distinctionbetween domestic care and moral treatment in ahospital in their "Remarks" of 1847: the institution eliminated the insidious effects of home life.and replaced them with an ordered. peaceful. andclosely supervised exisrence.wOrher argumentsaccentuated the need for specialized asylums forthe insane. In stressing the need for such institutions, Ray was oblivious to alternatives. Poorhouses and almsho uses, anathema to the hos pita lvisio n, suggested to Ray the specter of humancruelty and neglect. Like Dorot hea Dix, his lifeti me friend and frequent cor res ponde nt, Raymounted a st renuous attack on local provi sion s forth e insane.

The com mon notion that cases of chronic insa nity could be ad equately ca red for in a poorho use would not, accord ing to Ray. "be confirmedby a practical examination of the subject. Thosepersons who are desc ribed as being so quiet andcomfortable. will often be found banished to somehouse on the premises. where they are ca red formuch like the brutes by their side ." Unfortunately. Ray could not present a local example of suchbarbarism. The discovery in 1843 of Abram Simmons, an insane man from Little Compton whowas confined in an un heated stone cell. hadsparked the drive to found Butler Hospital. Sincethat time. however . no similar scandals had cometo ligh t . Nevert he less. Ray persisted by citing exam ples from othe r locales wh ich. he mai ntained.were certain to be replicated in Rh ode Island. Inhis Third A nnual R eport in 1850, Ray discussedthe Irish pract ice of burying the insane in neckdeep eart hen holes . The impli cation seemed obvious to Ray: "I believe ... it [ the Irish practi ce] isnot materially different from what rna, be witnessed not unfreque ntl y a mong ou rselves.':"

Not sa tisfied with th e proof offered by such isolated and distant examples. Ray had suggestedthe need for a thoro ugh inves tigat ion o f local institutions for the mentally ill. He assumed such aninquiry would document his assertions . Accordingly. Thomas Hazard in 1850 offe red his servicesto the General Assembly. Hazard. a founde r andvice president of Butl er. delivered a t tu-page report to the Janua ry 1851 session of the Gen eralAssembly."

107 ISAAC RAY

Hazard had ferreted out the half-frozen Sim mons seven years earlier. but in 1851 he presenteda surprisingly moderate appraisal of conditions inlocal asylums and poorhouses. He found abusesof three insane individuals kept in Portsmouth."one is now chained and has been for many years"- but he suggested that such instances proved tobe the exception. Of the eighty-six deranged persons still maintained locally, Hazard recommended only sixteen for hospital care at Butler. Therest. he concluded, "were as well situated as theycould be if placed in a larger institut ion.??

Though Hazard's findings seemed heretical toRay's credo, the Butler chief issued no retort. Heaccepted Hazard's statistical findings but discarded the conclusion that local institutions might offer adequate care for the insane. "If anyonedoubts that we are dealing with an evil of triflingmagnitude: ' Ray warned solemnly, "le t him bereminded that from the report of the commissioner appointed by the General Assembly, it appearsthere were ... eighty-six persons in the poorhouses of the State."44

The success of a hospital for the insane depended on something more than the pleas of a concerned humanitarian. Ray's familiarity with thelegal nuances of mental disease alerted him to theneed for formal commitment procedures. Thoughthe common law permitted restraint of those individuals whose freedom threatened public safety.Ray had insisted in his Treeiise on the MedicalJurisprudence of Insanirythat "th e great law ofhumanity" justified confinement in a curative setting. Writing in the Monthly Law Reporter in1850, Ray expressed concern that "the confinement of the insane is regulated in most, if not allthe states, by no state law whatsoever," The absence of statutory provisions suggested to him theuncomfortable prospect that "nine-tenths of ourpatients might ... be discharged by means of awrit of habeas corpus. and the officers ... liable to

a prosecution for false Impriscnmem.""In place of such threatening uncertainty, Ray

presented a draft for a law that would make confinement of the insane by medical certification alegally recognized procedure. He proposed in theAnnual Report of 1851 that friends or relativescould confine someone in an asylum whom theyconsidered insane with the approval of a judgeand the written certification of one or two "re-

spectable" physicians. attesting that the individual was indeed insane. In disputed cases. acommission of five or six would determine for thecourt whether the person's condition warrantedrestraint. The same commission could decide if aperson should be restored to liberty and wouldtherefore shield the hospital from the legal recriminations of which Ray was so fearful. Almostbefore the ink had dried on Ray's Report. theGeneral Assembly enacted a commitment law, thesecond in the nation. Except for minor modifications. the Rhode Island statute incorporated theprinciples set forth by Ray.<6

Ray and the trustees hoped that financial incentives from state government might also facilitate acceptance of Butler Hospital. Under theoriginal plan. the state's towns paid a yearly minimum of $127 for the upkeep of a single resident atButler. This figure compared unfavorably withthe annual COSt at local poorhouses, a mere $51.50by Hazard's account. To make confinement atButler an economic alternative to local care. thetrustees suggested that "the state defray a certainproportion of the expense of every pauper.':"

Earlier proposals for state assistance hadfailed , but the proposal of 1851 came when attitudes toward deviant groups were becoming moreenlightened. Beginning in 1850. the state offeredfree schooling to deaf and blind children in out-ofstate institutions, while the General Assemblyabolished the death penalty in 1852.The PrisonInspection Board noted that "an enlightened amelioration has been made in the discipline" of thestate jail : " Books are provided, not merely of moral and religious character, but books of travel andrational amusement, and leisure is afforded toread them...••

Butler benefited from these sympathetic attitudes. The Providence Journal commended thehospital's Annual Report of 1852 to "the attentionof the intelligent and humane in the hope thatthis will lead to an increasing interest in an institution which reflects so much credit upon thestate:' With little prodding, therefore, the General Assembly allocated one thousand dollars peryear to be used to maintain the insane poor at Butler. The state would contribute sixty dollars perpatient, while the remaining sixty-seven dollarswould be paid by the city or town in which thepauper had residence. By Hazard's estimate. the

108 ISAA C RAY

average town asylum spent $51.50 to maintain apauper, so that the state subsidy made hospitalization a frugal alternative to local care."

T hanks to the legislation of 1851. and the favorable climate, Butler ac hieved acceptance as theprimary insti tu tion for care of the insane inRhode Island. Legislati ve allowances for the careof the fX>O r and a flexible commitment law easedthe now of the insane into the institution. In 1852,only four years a fte r acceptin g the first patient,Butler received more referrals than it could accommodate.so

Because it cared for insane paupers, Butler resembled a public hospital. Since it was privatelycontrolled, however, it avoided the governmentalmeddling and close publi c scrutiny experienced bymost state hospitals. Ray , obviously pleased withhis independence, observed that Butler was "perfectly exempt from extraneous influence, the superintendent and directors acting in their severalspheres."!'

In using such freedom, Ray's Butler Hospital- in its first decade - offered an environmentsomewhat different from that described by thehistorian David Rothman. According to Rothman , reformers and medical superintendentsfounded insane asylums as "both an attempt to

com pensa te for public disorder in a particular set ting and to demonstrate the correct rules of socialorganization." Toward such ends, the internalmanagement of these institutions stressed regular ity, order and routine as an antidote to the chaotic demeanor of Jacksonian society. Ray, incontrast, offered no solutions to general socialproblems through the internal manageme nt ofthe asylum, though his crit ique of American society superficially resembled concerns expressed byhis cont em porar ies. Fo r example, in the changefrom a stable, disciplined agrarian society to theuncertainty and alienation of the urban and industrial age. Ray discovered the "secret-springs" ofmental derangement. Americans, he concluded.had forsaken the peaceful. healthy pursuits of colonial times for the contemporary quest for wealthand power. In doing so, Ray worried, they hadweakened the physical organ and invited the on set of mental disease.Sl

Yet Ray did not conclude that these cond itionswarranted removal from society. Thus, Butler'smanagement exhibited none of the strict disci-

pline so characteristic of the institutions describedby Rothman. Instead, Ra y sought constantly to

mitigate the tendency towards a hospital regimenbased on precision and regularity. "We are biasedby no theory: ' Ray declared in 1848,and his statement was borne out by the program at Butler. Instead of the trappings of militaristic regularity,Ray argued. hospitals should be furnished "withwhatever can approximate them to the characterof a domestic dwelling." He suggested that "everyyear should witness some addition, useful or ornamental, calculated not only to invite the return ofreason, but to relieve the tedium of con finemem.':" He also stressed "the importance of agreat variety of amusements, and especially ofsuch as req uire no effo rt on the part of the patient.?"

Acco rding to Ray, care rather than cure bestdescribed the function of an asy lum for the insane. This emphasis also set Butler apart fromother institutions . Between 1840 and 1855, asylumsuperintendents tri ed to surpass each other in reports o f the nu mber of patients cured by their respective hospitals. Some even claimed to havesuccessfully treated all of their clients."

Ray worried that such simple statistical evaluations of an asy lum's worth would lead the publicastray. A single percentage figure offered a ready,though inaccurate, index for assessing the valueof an institu tion and did not, according to Ray, dojustice to the careful but usua lly unspectacularwo rk done by mo ral rnanagers.w At Butler therate of recovery rarely topped fifty percent of thepatients discharged; Ray indicated that about onein three of the patients referred to Butler left fullycured.

It was this vis ion of the peaceful, quiet, professiona lly managed asylum that Ray and the trustees sought to protect against the incursions ofimmigrants who streamed to Rhode Island'ssho res throughout the antebellum period. In 1850,one-sixth of Rhode Island's population was of foreign birth; fiftee n years la ter, mo re than a thirdclaimed alien birt h or foreign parentage. The rising tide of immigration prompted a spate of nativism in Rhode Island, which reached a climax in1855 when the Know-Nothin g party swept thestate elections."

Ray and the trustees shared in the xenophobiaof the times. As early as 1850, the trustees be-

109 ISAAC RAY

moaned the (act that "aliens and strangers sho uldhave mo re reason to bless the benevolence thatopened to them such an Asylum, than ou r nativepopulation (or whom mainly it was designed." ToRay. the foreign presence was far mo re troublesome. Moral management proved ineffective withforeigners. a failure which Ray attributed "insome degree ... to an inability to approach themin a proper way." In particular, he concluded in1856 that "the Irish ... are preeminently incu rab le.W~ are bound to expect. therefore a ronstantly Increasin g accumulation of incurab le casesfrom th is quarter. a (act that must be taken intoaccount in ma king provision for future hospitalaccomodauons.':» The sta ble world of the antebellu m asylum seemed threatened by a populat ionim mu ne to its ministrati ons.

Beginning in 1857, Butler Hosp ital in it ia ted arestr ictive admissions policy, that had the effectof excluding many of the for eign born . T be trustees requested that P roviden ce an d othe r towns remove their pa uper insane , most of them of fore ignextraction, from Butler. Some of the de rangedwere returned to local asylums and poorhouses,but many others had no residency in the state andtherefore did not qualify (or local r~lief.)I ConIromed with the problem of la rge numbers ofhomeless pauper insane. some municipalities began - with financial assistance from the state to send their indigent deranged to hospitals inVer mont and Ma ssa chusen s.w

Those removed from Butler wer e chosen according to et hn ic groups. Of the seventy-eightpau pers remaining at Butl er in 1865, only twelve( fifteen per cen t ) were defin itely of Irish background. In cont rast, Forty-two percent of thetwe nty-four Rhode Island paupers support ed inVerm ont had Irish surnames." Butler's decision tolimi t admissions of the pauper insane clea rly refleered nat ivist prejud ices.

To Ray. the logic behind the creation o f an exclus ive retreat serving only the native born wassimple. Proper medical ca re of the deranged depended on the abili ty of su perintenden ts to practice mo ral treatme nt. Since the Irish appea red toRay to be impervious to mo ral the rapies, Butler'smairuainence of Foreign barn would deprive others. presumably those of native stock. of a chancefor recovery.

In his book entitled Mental Hygiene, publish ed

in 1863, Ray furthe r elaborated the rationale forthe selective asylum. A he reditary predispositionseemed to him as important as environmental influences in creating the deranged mind. Raywarned that "intimate associations with personsaffected with nervous disorders, should be avoided by all those who are endowed with a susceptible nervous organization." He recommended aprogram of professional intervention befo re theweakened constitution could succumb to such exte rnal threars.v Yer who bu t the wealthy cou ld afford to use the mental hospital as a retreat fromthe pressures of everyday life?

Though Butler sti ll accepted pau per pat ientswhen Ray resigned in 1868, it did so less out of ade sir e to se rve all of the insane than out of a needto keep its beds full. Rh ode Is land's Secretary ofState reported in 1864 tha t "Bu tler rece ives statebeneficiari es whe never it has roo m for them"; twoyears la ter, he no ted that Butle r proved "unable.from want of room, or from other causes, to receive the state's insane.t'w

Dr. John R. Sawyer, Ray's successor. clearly articulated the hospital's new policy. "But manycases arise of persons who have no friends to visitor care for them: ' he wrote in 1869," foreignersperhaps. wit h no ties to person or place. who areincurably insane . , . it is the truest charity as wellas the wisest policy, to recommend the removal ofthis class to other institutions ," The trustees obviously agreed with Sawyer; in 1871 they cheeredthe fact that (or the first time in its history, Butl erwa s fre e of the pauper insane . In st ead, the hospital now served what they called a "be tter class ofpanerus.'>'

By then. Ray had retired to P hiladelphia,where he en gaged in a lucrative pract ice as an expert psych iatric witness un til his death in 1881.65

His visio n of Butl er a's an instit ution caring for allof Rhode Island 's insane had vanished by the timeo f his depart ure from the state. Confronted by anin flux of aliens who seemed to threaten the peaceful world of Butler. Ray and the trustees ha dshrunk from the ir se lf-appointed responsibility ascaretakers of all th e state's insane and ushered inan age during which Butler served only a limitedsegment of the deranged.

Following Ray's suggestion that "the comfortand restoration of the insane are best secured bykeeping the curable and incurable in diffe rent es-

110 ISAAC R AY

tablish ments," several states had beg un in th e18605 to create large, custodial institut ion s for thech ronically ill." In 1869 the Rhode Island Gene ralAssem bly authorized construc tion of a Sta te Asylum for the Incur able In sane.

In theory, the opening of the State Asylum in1870 marked the beginning of a system of caringfor the insane that made optimal use of facilitieswithin the state. Butler would minister to the curably insane, while the chronically ill could find ahome for life at the State Asylum in Cranston. Inreality, potent social values of nativism and fiscalconservatism made Burer an institution of last reson for the poor. To the pauper insane, the st a teoffered only the custodial facilities of the Cranston Asylum, This segregated system of hos pitalcare remained unchanged for the next century,Until 1978. when Butler again began acceptingpublic patients through an arrangement with theProvidence Menta l H ealt h Center, the state institution at Cranston was the final resting place formany poverty-stricken mentally ill.

s- for ell&mpl~ David Rothrn&n. Th~ DiKo""Y of lh~ Asy·lum (Bo.ton, 1971) , 109-129; Norm.an Dair>.Ccnc~pu of Insanilyin rh~ Unjr~ Sr.. rt'll, I769-J9IlJ(BrunawKk. N,j.. 1964), 74 fl. ;GIM"a1d Grob, M~nl.J lnalitul;';"" in Am~m...' Social Poii<cy to187$(Ne-wYor k, 1913) ,

2 Rothman, DiKowryol rh~ .....ylum. 133.

3 Some of Ih~ wbHquent an.olysi. of profnaionaliam i. baaed onT.. lcort P..non, "T he Pro fnaion...nd Social StfUC'tute," in Ell·")'II on Sociological Thft>fJ'(Glenroe, 19s-4), 34-49 and E liotFri~, ProI_ionol Medicjn~(N~w Yor k, 1972), Ch .. I1·IV.

4 On the backgrounda of Am~rican medicallUperintendenta. roeeDain, Connpra ollnsanity. 57·SS; Rot hman, Di!JCOwryol theAsylum. 109-129. and Winfred Overholroer. "Th~ Founding an dthe FOIlnd~rsoltht Auocia t;on," in ].K. H all, ed" On~ HundredYt ars 01 Amerie:anPoych ia rry (N~w York. 1974), 46-52,

s J acq ue. M, Qu en, ..I....e:Ray and MeRta l H ygie ne in Am erica," An na ll 01 rh.. New York Ae:..demy 01Sc:ierKt'lI, CC XCI(1977),83,

6 Ibid.

7 Edward Jarvia. " Memoir of Georee Chf)'ne Sh ..tl1Kk, M.D.read April 12, 1854," SIdney R i d~r (glltction, John Ha l' Lbrary,Brown Un;"enity; Quen, " laue: Ray," &J.

8 Quoted in Qu.-n.~ I aaac: R..y. ~ &J.

9 Ov~rholH'r. " Foundinl of the AMociaI>on," 67.

10 Ray', penon.aIlibr_ry, maintained _I Bull ..r HcapitaL indudtl PhiUipe Pinel. Tn..r'-'r~OI'I Mm w AIR-nation (London.

1806); Jean Eli~nn~Dominique Eiquirol, Menr..1 M~I~di<'S, ~

Tn"liM' on [nunily. Samuel Tuk~, Dncr1plion ollhe Rern~ r

(Londno, 1813): Franz G..U, Eapt.-lrion 01 rh~ Physionomic: Doc:Inn<' 01 Dr . Ci~II(Pari.. 1822) ; Ga.par Spullheim. Phr..nology,or rh.. Doctrineo/lhe Mind, ~nd o/lhe Relar~bool~n;u;MMli l ...r~fiomand lhe Body (London, till)): .. well '" workl byAndrew Canbt. and hia brother Georet ,

11 Andrew Scull. ~From Madnna to Mmtalillnea.~ Archi"f'f'fEuroptt~M SocioJogit. XVI (197SI, 218-261. MId Scull. ~Mad

Docton and M~e,atr~ tn: Enllilb Ptydti.atry ·. Stnlllie for Proftelional Autonomy inth.. Ninrt ....n th C..ntury.- .bid. XVII(1976), 2N-3O.!, provide a tlIffuJ framf"'Ofk for undentandinlRay'. caren.

12 Quoted in Scull. "F rom M~na to Mmtallllnn.,' · 226

14 Ibid.. Z»-2s-4, 2)); John D. Oavift, Ph"noIogy Fad MId Srienc.., A JlI'fh C<'ftflU}' Am.tric:~n CrttUdt(N~ Ha"f'fI, 19S)).91.

I) Iaaa.t: Ray, A Tn.. tlM 0t'I rhe MniKIII }lUDfJ'I'IlfNna oIIrt5.al>-ity(Bc.ton. 1838).

16 For an account of th .. 11K of tradll..,...] medical th~....ptn;nthe can of Ihe insane. ..... Oain. C«>cepq 01 [/lUnIfY, 10.

17 lbKl. 26-27. 31,31.

18 Ray, M tdK.J }UNptrUMr>ct. 69.

19 [bOd... 39

20 Da>'ifl, Phr..noJogy.).

23 Ov~rholaer, "Foundinl of the AMOC;at ion," 69; I......c Ray toRobe n H I" ft, Ja n. 8, 1844, F~b. 12. 184), BUller H"'pital Pa·pt.... John Carter Bro wn Library, Brown Uni"..rs; ly, h..rea ft..rd leduBHP.

24 For bac kerounda 01 But ler '. found ell. roee B;ographie:..1Cy·dopedi. 01Reprf8<'nr~ fi"e Men in R hode lalllnd (Pro" idence,1881),166,227,2)'1, an d R~pr~8~nra ri,,~ Me n and Old Fllmilies 01Rhod.. laland(ChiCIIIO, 19(4),966.

25 "Remarkl of Ihe Truaree.." Chaner 01 th e Burler H",pillli lorIh~ Inaan~; P roceedinl . under Ih~ Sam.., R eports 01 the Trull'us. etc. ( Prcwid~nu, 1847). 36-37. S- alao Lulher B~ll. " ModemIm pr-O\'emem . in the Conatruc:tion. Ventillltion, and Wannin g ofBuild;nl" for Ih.. l nLane," Americ:~n journal ol lnunify, II(lIloU), 13-35. which include. Btlr. plan for Butl~r Hospital. andIIUI: Ray . ..Dt.cripuon 01 But l~r H..pita!. " American jourmlolIn..niry, V (l848), 1·20.

26 Luth~r BtU 10 Robtn H I".... May 21. NO\'. 22. 1844. BHP.

27 Ray, ~Dnrnption of ButllM" U..piw,- 17.

28 Set BtU, " Modem ImprO'l~m~nta.- 21·30. and Ray, ~Dnrnp'

tion of BuIlIM"HOIpiw.~ 11·17.

III ISAACRAV

2'9 Ray, " De.cri pt ion of BUIIM H-.pita!.'· 3-4.

3(l Ibid" 7-11.

31 Ibid, WI

31 Ibfd..2. II

33 M.. ,.... ln ....n~ Hc.pw . Fih h A nnu.alR~pon (Eutpon. 1&44).13; 1LU<: lay. M~nrM Hy,.~n~ (R~prinl; N"" V...k. 19'68). 331;" Rf'fNIr ka of Ih~ TnIaI~~ 29

1.S Rhock b\a;nd G..n Mal "-mllly. Am.ltld Rno/ws. Jan.1847. S8

37 R~pon of Ih~ 8o.Ird of Tn.r_ oIrM Butln H.-pnn for rh,lnu.n~(~. 1841) . 4. 7; R~potU oI rh, Trusr_ V>d~

~rinr",dnll oIth, Bvrlff H.-pIlM for th, Inurw(~~.

1849). 7. Th~ 1849 upor1 indllolk. Ih" t.o.pil.lra ~xpenditurn

and rec",pta foo- .h~ IirR thin....n months of ih opention.

38 R..pon.. 1849. 13,

39 Ibid.. 14

41 R..pon.. 1849. 26; R"pon.. lMO. 24

42 ThomM R. H uard. R~port on th, Poor.llnd Inun.. in Rhod~Isblnd M..d~ ro rh" O..n"s/ Auc-mbJy ar ;ujan~ St'SSion./8J / ( Provid"nce.IMl).

43 Ibid., 96

44 R~pon.. 1833.23.

H Ra y. M rdic. l juriaprtJd~nc,. 495; "wgal R elationa of the Inaan e," Mont hly L..""R,pon .., (S~pt. 1830). J; R~port-. 1832. 21.

4(i Reports. 1831. 14·16; Rhod.. h land General Aasembly. Acrs.lind RelJOlvrs. IM 1, zo,1'6

47 Hazard. R ..pon on rh .. Poor and In. lme. 64; Repon!J, 1MI. 18.

48 Phillip E ng1iah Mackey. .. 'T he Rnulta May !It' Gloriou" Ant i-Ga Uowa Movem"nl in Rhode hland.~ Rhode Island H ,srory. XXXIII (1974). 28: ProYid, nc.. j04JmaLJune 17. 1854.

49 ProYid~tIC.. joomaL Feb. 25. 1M2; H uanf. R..pon on th ..Poor and Im.ane. 64 ,

so R, pon.. 1833. 13

51 R..pon.. 11163. 31.

52 ROIhman. DIanw~ryo/ rh.. Atoylum. 1.....145. 154; Ra y. M ..mnHy,.~ ISS, 236.

H R..pon.. 11149, 21; R~pon.. 18-S8. 17,

54 R~ptXU. 1137, 22.

53 R~pon.. 18-S8. 12·13; nain. COflUpr. o/ inSol/liry. 114; ROIh·mIIn. ~""ryo/rh.. Aaylum.13H32.

36 R,pon$, 1S50. 22.

57 Urry Anthony Rand. " T he Know·N OIhin g Pany in RhookI......nd. ~ Rhod..ldand HmOf")', XXIII (1964). 108,

-S8 Report.. lMO. II ; Ray . " Repor1 on lnaanilY.llnd Idiocy in Ma..IoKhuM'lu,- Nonh Am,ncan R"vi_ . LX XX II (1856). 87.

S9 R,ponto. 1139.6, UnckT Rhode laland', atric1 ""tlnnenl laws,th" moM lIlrinee'nt in the nation by lOfIte Ka.IWlu, only resi·Mnta of a panicua.r city or lown wen ~Iicilll" f<.-Ioal ",lie f.Ot.he-n who did ncx own land could be ~WUTled <xIt~ or ~edfrom a partictdar~ SoH Marear '" Crr«h. Th .- C.....turift 01Poor ~w Adm inlS1ra rion (Chkago. 1936).~ joKphBrennan. SocW CondsrioN in IndustrW R ho<k Island. 18JO.-lS60(Waahineton. 19401.

60 GKll"ge Wigh~ " Annual Report of th"OvenHl" of thePOOI',~ Providmc~City Counril. CiTy Doc-unTftlt No. .J9(J>royj..denc:~, 1869). 2. deKribN Ih" remoYa! of PJ-c,..;do-n<:,,·a 17 ~uperinaane from Bud ...- to Ih~ V~llnun" Hc.piul in 1858.

61 John R. Banl,,", R..pon OlItM srar~ &_IicUri /865.Rhod, Ialand Gen...-al AaHm bly. AC'taand Rno/v Pub/;c Doc--wn t!'nr( Apprndill) No. 10.1ll6S. Of th " 24 Rhode bl.and ~tientaat V" nnoIll, I have counted th~ foUoo';ne at be1ne of for";gnbac:lr.eround M~MuUe'n. MeGwi n. Gal lIeher . MorrilIHy. K elwy,o..m~, Charnley. Fannine . Riley . KlIY~,h. Kennedy .MeGuir". 1bfd.. 6. AI Bud"r, of 7S""t~ pIIti"nu, 1hoat!'"'; th for ";en aurnames Wer,,;~yjn~. McK"nna. O ·Bri"... O·Rourile.O ·M ar a. Corroran. O ·N";'I, K~nnedy. Riley and F inney, Ibid.. H .It ia aitooim " . n tine to ncx" Ihat Providence. wilh 30 percent ofth~ .ta",'a popIIlI t ion in 1ll6S(one-qua n er of t h..... of forei gnbinh) aC'COUnted lor 30 perc"nl of t h~ indige'nl ina.ane at Ver mont , bill on ly 22 percent of Ihe publk plItienta at Butler. Ibid..H . s..." alao Edwin Snow. C~naWl of Rhodt' Islan d, 186J, iii-iy.

62 Ray . M~mal Hy,i~n~ 163. 174.

63 John R Barll'"'-I , R~pon on rh.. Sta .~ &n..ficiari"- 1864.Rhod~ 1., land Gen~.al Atoat'mbly. Ac to and RnoIyt'ti. Puhlic Doc-urn..nt (Appendix) No. 2. 1864.9. and Banlell. ReporT on rh,sra... &n../kiari.... 1866, Rh od" b land G..n..ral A....mbly. Act>!and Rno/y.... Public Document ( Appendix) No. 12. /866. 7.

64 Overhol.e•. " Founding of the Auocia,ion:' 69;R~ 1873,3,

65 Quen, "lseac Ray: ' 93,

66 I....ac Ray 10 DoroIh.... Dix. Feb. 20. 18<'3. Dorothea Dix Pa.pe", H "",g ht on Library . H arvard Uni ve.....ty, In But l...-H c.piul.R ..pon.. 18S0. 31,32, Ray wrot." Iha t " wlI hin a I"" yea ... thia d...acriplion of p11li"nta [,h~ lonign born] h... gr ea tly incr eaaed inall OUr "'-pi",l.. and rontribu,es in no tri fling degr.... 10 a"",Uth.. burdrn of pau periam thai haa bHn augme'nting with a rapid.ity that il truly appalli nC.~ and " ndoned tl>~ idea of n ubliahingat'paral e matilutiorlto lor th" incurably i~ne among the lOIt!'ignborn.

112

VACCINA"VB.

NSMALL POX!

There is a case of Small Pox on Plane st reet,and cases of Varioloid on Sheldon, Transit,F r iendsh ip, Plane, Broad, Bridg-ham, Carpenterand Claver iek streets, and on Broadwnv.,

Our cit izens will see the importaneo of'attending- to the vaccination of their childrentolthout delay.

Vaccination is free to all residents of the citv,,at the Office of the Board of Health, l\IarkctSquare,

EverySaturday,trom12 to lo'clockP.M.Physicians and others are requested to give

iuformntion to the subscriber, of all cases thatmay come to their knowledge.

EDWIN M. SNOW, M. D.,SlIp't of IIt,,,lth,

l"ro,-idt'Jlt,C, January 2", 18«;2.

A.. ~Mly .... 11161. Provi~I1('~ '~IS .....I? urgN fO h.a..., Ih~irchildrrn v.accimf~ ~t..".r amJIllpoJl_Thr ",uVM"ci~tion conlro""""'y. howrvC'r. cOrllin UC"d untd rhe' rum of rhe' ....ntwy.

113

Smallpox Vaccinat ion:A Leap of Faith

In the wo rds of sociologist Robert Mert on , onegeneration's scientists "stand on the shoulders ofgia nts" as they perfec t ideas and theories firs t deve loped by their pr edecessors.' The st udy andpractice of medicine fits neatly into this model.Knowled ge o f disease seemingly progresses fromindistinct. ga rbled theory to scientific truth; physicians emerge over time from unprofessional beginnings to a position of respect based on theirexpertise.

T h e history of the fight against smallpoxsee ms to rein force this model of th e progressionof scienti fic knowled ge. for the chrono logy oftreatment su gges ts that physicians be gan in confusio n, und ert ook ex perimentation. and finallydiscovered truth. In i72 1 Lady Mary Monta gu int roduced in E ngland the Turkis h pract ice of inoculation with live smallpox matter - a practicepopular with people willing to contract a mildcase of smallpox to avoid a severe case during anepidemic. Unfonunately, though inoculation gaveim muni ty . it also gave patients the symptoms ofsmallpox: dis figurement, blindn ess, and occa sionally dea th. In addition, the inoculated per son wasconta gious. William Jenner in 1799 imagina tivelyinteg rated th e vogue for inoc ulation wit h Devonsh ire folklore (Devonshire milkmaids did no t getsmallpox - an immunity attributed to handlingcows sick with cowpox). Jenner "tested" his hypothesis that exposure to cowpox protecteda gai ns t smallpox, statistically presented his findings, and earned accolades as well as thirty thousand po unds from a grateful P arliament. Inst eadof inoculat ing people with live smallpox germs,

OM..R~ i5a doctoral cand,w,t.. ,n IOCiology It Brown Uni·" ..n olly.

by Joon R ersinas*

Jenner vaccina ted them with cowpox. Vaccina tedpeople were immune to smallpox without riskingthe contagion or sym ptoms of inoculation. As aresult , Jenner won intern ational renown. T heDo wager E m press of Russia sent Je nner a ring,named the first vaccina ted ch ild "Vaccinof£," andguara nteed the child's ed ucation at state expense.Napoleon in 1805 ordered universal vaccinationfor F re nch troops and - to the surprise of all he re leased an English prisoner who was rela tedto Jenner: " Ah. it 's Jenner! I can refuse Jennernot hing.":

Benjamin Waterhouse, a Harvard professor ofmedi cin e, received a sample of Jenner's lymphand dist ributed it widely . O ne reci pient wasThomas Jeffer son, who the rea fter pr eached thewonders of vaccinat ion. Soon a European-trainedcadre of physicians practiced vaccination. Publichealth boards in American cities and towns, besieged by intermittent epidemics 0861,1871,1888). used vacci nation as a tool against the disease. Health records in Baltimore reveal that upto fifty perc ent of the population was vaccinatedin 1871.3 In Rhode Island, public h ealth officialssuch as Dr. Charle s Chapin, Su perintendent ofHealth for the City of Provid ence , and Dr. EdwinSnow, his predecessor, advocated vaccination.E ventually, states passed legislation ma king vaccination compulsory for children in public schools.T he campaign was so successful that by the 19205smallpox epidemics we re viewed as a historica lph enomena belonging to the days of "prescienriIic" medicine wh en untrained quacks proffer edtheir own int er preta t ions of he alth and illness. As

114 SMALLPOX VACCINATION

for "ant ivacci na tors" - those people who opposed compulsory vaccination laws - publichealth texts tod ay discount them as misguided obstructioni sts arguing a gainst science."

These amivaccinarors. however, deserve a second look . One way to reassess their role is to question the validity of Robert Merton's analogy ofscientific progress. His analogy suggests that Jenner "stood on the sho ulders" of Turkish inoculators by perfecting a vaccine that seemed to be sosure a safeguard. Antivaccinators, by contrast, appear as obstructionists - doubters standing in theway of progress.

Thomas Kuhn. a historian of science, has challenged the view of scientific progress as linear andevolutionary. For Kuhn, scientists work within aset range of theories, methods, and techniques(" Normal Science"). He calls this limited worldperspective a "paradigm" and emphasizes that,throughout history, one generation's scientistshave usually worked within the same paradigm.Reality, though, is kaleidoscopic and whenanomalies, problems, or puzzles accumulate, scientists - usually younger ones - begin to formulate a different paradigm. According to Kuhn, thetransition of scientists from one paradigm to an other is a "scientific revolution." He stresses thatone paradigm is not necessarily superior than an other; in fact, available data may still support theolder paradigm. Some scientists, however, make a"leap o f faith ," hoping that a new perspective willyield answers to unsolved puzzles.' In light ofKuhn's notion, antivaccinators can be seen not asquacks or obstructionists but as a group who embraced a new paradigm by making a leap of faith.

In late nineteenth-century America, as statehealth departments began to legislate and enforcelaws making smallpox vaccination com pulsory forchildren entering public schools, antivaccinatorsdebated, questioned, argued, and resisted. Since1880, England had a vocal Antivaccination Society whose ranks even included members of Parliament. This society published a monthly journalthat railed against the vaccination menace.Gradually, English articles, books, and tracts thatfound their way into American homes helpedspawn antivaccination efforts throughout the

United State s.In Rhode Island, thanks to a retired toolmaker

who dedicated his last years and most of his fortune to opposing va ccination , the campaign wasvigorous. Samuel Darling, born in Vermont in18IS,left his family 's farm to become an inventorand manufacturer of machine and other tools. Ashead of the firm of Darling & Swarts in Bangor,Maine, he moved to Providence in 1866 when thefirm merged with its rival , Brown & Sharpe.When he retired in 1893at the age of seventyeight, Darling had earned considerable respect asa philanthropic, hardworking industrialist."

After his retirement, Darling worked to convince the General Assembly to repeal a one-sentence law passed without opposition in 1881 thatmandated vaccination for public school ch ildren.The law declared that "no person shall be permitted to attend any public school . . . unless such aperson shall furnish to the teacher ... a certificateof some practicing physician that such person hasbeen properly vaccinated as a protection fromsmallpox." To persuade Rhode Island legislatorsthat the law should be repealed, Darling financedthe publication of antivaccination writings: minutes of the London Anti-Vaccination Society (amonthly journal), antivaccination tracts fromEnglish and Canadian writers, and books and reprints of speeches made before the House of Commons urging conscientious objector clauses toEngland's compulsory law. The Lowell (Massachusetts) Board of Health in 1871 had declaredvaccination ineffective in combat in g the city'ssmallpox epidemic of that year; twenty-one yearslater, Darling reprinted the entire board report.'In 1894 he subsidized the visit of Jonathan Pickering, a leading British antivaccinator. to Rhode Island. Addressing a joint session of the GeneralAssembly, Pickering urged repeal of the vaccination law. Pleading that vaccination was "thegreatest fraud ever perpetrated upon the HumanRace," Darling sent each legislator a "japannedtin box from ten to twelve inches square, withlocks and handles and filled with books, pamphlets, and leaflets, by the highest authorities,containing overwhelming evidence against vaccinatton.:"

Relying on English statistical evidence and theskepticism of some physicians. Darling believedva ccination could kill, maim, and disfigure as in-


sidiously as smallpo x. He abhorred the lunacy ofmandating a torture that served only to enrich amercenary medical profession. In exposing thedanger of infecting healthy children with the diseased lymph of a cow. Darling saw his mission aseducator - he assumed that once legislatorsknew the facts about vaccination, th ey wou ld repeal the law. "From conversation with many substantial men upon the subject:' he wrote, "Iconcluded that every intelligent unbiased personwould at once condemn vaccination." I D

Another prominent Rhode Islander sharedDar lin g's cause. Sidney S. Rider was an antiquar-

ian book dealer who for th irty-three years published a series of weekly Book Nares in which heliberally sprinkled antivaccinarion homilies.' ! Rider amassed clippings from Eastern metropolitannewspapers as well as items from Darling's japanned tin boxes. He also corresponded wit hSa muel Leonard , the ma yor of Leicestershire.England, to lea rn how that va liant town with its60,000 unvaccinated souls had succeeded in ignoring E ngland's compulsory legtslation." Riderag reed with Darling's assessment of vaccinationas bestial torture effective only at replenishingmedical coffers, yet he added a concern that


would spark less vehement antivaccination sentiments throughout the country - the distrust ofstate interference in so personal a domain ashealth.

American antivaccination efforts gained fewvictories, although men like Rider and Darlingdid help to slow public health campaigns. In 1903Minnesota abandoned its compulsory law; in 1911California repealed its law. Samuel Darling neverconvinced Rhode Island legislators to repeal the1881 law, but he came close. In May 1893 a bill torepeal compulsory smallpox vaccination forschool children passed the state Senate by a voteof 16 to 9, but it was later defeated by a small majority in the House." The editors of all Rhode Island newspapers by 1895 agreed that the merits ofvaccination might justify the technique but thatany law fomenting such opposition should be repealed. Even Chapin. a staunch advocate of vaccination and Darling's adversary in the press,agreed with the editors. "

The 1881 statute provided no recourse to parents who abhorred vaccination. If they refused tolet their children he vaccinated, then theoreticallytheir children would not be allowed to attendschool. although school attendance was obligatory by law. An 1896 law stipulated that parentswho refused to comply with compulsory vaccination legislation would be fined . Presumably, children of parents wealthy enough to pay the finewould be allowed into the public schools. RhodeIsland antivaccinationists would have welcomedan amendment that allowed a parent to furnish, inlieu of a vaccination certificate, some proof of"unfitness for vaccination" to teachers, as Massachusetts had allowed in 1894.'lOne Massachusetts senator. however, "exhibited twenty-five orthirty certificates which he said were issued by'antivaccinationists.' who advertised to furnishany number of them to anyone.':"

Darling died in 1896 and with his death thespirited antivaccination campaign graduallywaned. The state Board of Health was strugglingto cope with other contagious diseases - scarletfever. typhoid, diptheria, measles, tuberculosisbut miraculously Rhode Island seemed immune tosmallpox. As late as 1899, Chapin reported thatnobody had died from smallpox in Providencesince 1883.11 One result, of course, was lax enforcement of vaccination. Other than Providence,

Rhode Island cities and towns responded slowlyand haphazardly to state health edicts. Routinely,the state board sent questionnaires to city andtown clerks asking for reports on new sanitary ordinances, the number of people vaccinated, a tabulation of the incidence of disease, and thecooperation of undertakers in reporting deaths.Chapin would reply for Providence with pageupon page detailing local ordinances, statistics, results of studies, but other communities would ignore some or all questions, offering crypticassessments at best. v Twenry-rhree communitiesin 1899 reported that they did not offer public vaccination; twelve did offer vaccination, but someonly to school children. In 1902, the year of asmallpox epidemic, fourteen communities reported that they did not offer free vaccination. Fifteencommunities reported free vaccinations that year.hut eight municipalities either ignored that question or the entire questionnaire. Amazingly, Central Falls reported that "nothing for thepromotion of public health has been done duringthe year.':'!

The state was poorly equipped to wage a campaign. Newport was the only community with aboard of health distinct from its board of aldermen. As late as 1902. West Greenwich employedno health officer. Even those communities thathad health officers lacked basic methods of record-keeping. The Tiverton town clerk in 1890noted. "I think nothing was done about it [freepublic vaccination] in 1890, but Dr . Yale was employed in 1889, I think. " The state had no laboratory until 1888.20

Except for Providence, where Chapin hadsponsored free public vaccinations steadilythroughout his tenure, Rhode Island communitieswere not prepared for the smallpox epidemic of1900-190V1 In 1900scattered cases of smallpoxappeared, and despite quarantine and isolationmeasures, an epidemic spread throughout thestate, peaking in 1902. Woonsocket, the city worstaffected, reported 370 cases, with only 25 deaths.The disease was mild : Providence reported a mortality rate of twelve percent (compared to Boston's fourteen percent). Yet the prevalence of thedisease frightened legislators. The City Council ofWoonsocket in 1902 passed a resolution "that thedelegation from Woonsocket to the State Legislature he instructed to secure, if possible, legislation

l


in favor of com pulsory vaccination in the State ofRhode Island:' Woonsocket councilmen, and Dr.Chapin, wanted to make vaccination compulsoryfor adults as well as children .v

"Substitute Bill A,"which provided for compulsory adult vaccination, aroused dormant antivaccination qualms. Legislators in the House ofRepresentatives debated this bill for an hour anda half. At a time when public health departmentswere bringing down death tolls from cholera andtyphoid, joseph McDonald of Pawtucket cautioned : "T h e statement that smallpox has disappeared practically is not proof that vaccination isresponsible. Sanitary science is more directly responsible... , I( the city of Woonsocket wouldspend $30,000 in cleaning the city, more would bedone than by vaccination," He cited speculationthat the vaccine itself bred a coterie of diseases inc1uding "poisonous virus ... that may disfigure (orlife." McDonald said he knew "one man withhands and arms all twisted and blind in one eyefrom vaccination. Out in Warwick a man in perIect health was vaccinated and within fifteen dayshe died o f a most revolting disease." William Morgan of Providence doubted that vaccination wouldeven guard ag ainst smallpox: "I( vaccination is apreventive. why do so many have smallpox afterbeing vaccinated? ... No physician will guaranteethat smallpox will be preverned.v"

McDonald also argued against this arbitraryencroachment of government upon individual Iiberry: "This matter of government compulsion isa tremendous exercise of governmental power. Ifa man has any rights, they are over his own person, and to compel a man to take poisonous virusinto his system that may disfigure him for IHe isgoing beyond the rights of Government, I wouldleave vaccination to each individual." Morganconcurred. objecting to "any law that compels meto strip up my sleeve and be vaccinated with onedisease to escape another that is not likely tocome, I don't dispute vaccination itself. but lobject to the compulsory part. I think it is questionable whether the state has right to insist oninoculating people with disease against theirwill," Representative Adelard Archambault, aWoonsocket physician, believed that cities andtowns, not the state, should decide on vaccinationmeasures. john Ogden reponed that his NorthProvidence constituency opposed the bill. The

Providence ]oumalnoted the "significant (actthat two of the remonstrants came from theRhode Island city [Woonsocket] which has beenthe most afflicted from smallpox." Finally, by avote of 24 to 17 , the House of Representatives sided with McDonald against the legislation."

just as legislators divided over the vaccinationquestion. so too did physicians. "Irregulars,"those who espoused a distinct theory of treatment(hydrotherapy. allopathy, botanic thomsonism,mesmerism, homeopathy), spurned vaccination byoffering their own psychic. chemical. and herbalremedies, Dr . Franz Hartmann's book , Diseases ofChildren and Their Homeopathic Treatment.suggested sulphur. thuja. tartarusstibatus. and arsenic for smallpox. Frank Kraft, another homeopath, recommended malandrinum. while theHahnemann Society of Homeopathic Physiciansalso objected to vaccination. Until 1889 a majorityof Rhode Island physicians were irregulars, andeven Chapin studied under a Providence homeopath after graduating from Brown in 1876.lS

Regular physicians accepted jenner's technique, Darling, however, reminded legislators in"Medicine is not a Science" that these regularphysicians were the same healers who had oncepracticed bleeding, sweating. and inoculation.Henry Constable, a British antivaccinatcr, notedthat physicians used to prescribe a decoction ofturmeric for jaundice, a decoction of red roses forloss of blood, and scarlet bed curtains for scarlet(ever. Antivaccinators hoped legislators eventually would outlaw vaccination as they had outlawedinoculation, the earlier "cure," As RepresentativeMcDonald declared, "The history of medical science shows a constant change. What is acceptedin one period is not accepted in another.':"

Nineteenth-century Americans took the pronouncements of these medical regulars with a judicious grain of salt. often making physicians thebutt of their jokes. In the 1880s the competitivearray of healers and cures compelled patients totemper prescriptions with common sense andgood humor. One anecdote recounts the tale of aFrench woman, ninety-two years old, who willedthe contents of her medicine cabinet to her physician; opening the cabinet, the doctor discoveredunopened bottles and vials of all the medicines hehad prescribed - the secret to her longevity."Darling noted in one tract that "Oliver Wendell

118 SMALLPOX VACCIN ATION

Holm es, Sr., declared man kind had been druggedto death and that the world wou ld be better off ifthe contents of every apot hecary sho p were emptied into the sea , thoug h the consequences to thefishes would be lamentable."

Da rling, Rider, and McDonald also recognizedthat vaccinating physicians had a vested financia linterest in the technique. Tract after tract detailed yearly fees pocketed by public vacci nators,not to mention the fees collected by pri vate physicians.a "Doctors are paid to vaccinate," wroteHenry Constable, "paid again a bonus for doing itwell , and paid again for attending to the sicknessproduced by this blood poisoning." Ant ivaccinators reminded readers that Jenner collected$150,000 from a grateful Parliament, and thatAmerica 's Benjamin Waterhouse had ask ed theMassa chusett s legislature to reimburse his services."

Even the scientific community of the lat e nineteenth-century did not unan imously accept thelogic of vaccination. The leadi ng academic antivacc inator was Dr. Charles Creighton. at on e timeDemonstra tor of Anatomy at Cambrid ge.Creighton had supported vaccination until 1876,when E ncyclopedia Britannica as ked him to wri tea chapter on the subject. He concluded that William J enner was a charlatan. In Jenner and Vaccination: A Strange Chapter in Medical History,Creigh ton attempted to expose Jenn er's quackery." The ninth edition o f the Britannica includedCreighton 's assessm ent that vacc ination wouldnot preven t sma llpox.

Or din ary citizens also shared Sa muel Darling'sdist rust. In 1903. spea king before th e ProvidenceMedical Societ y, Don ald Churchill warned that"vacci nation was fought almos t as fiercely as inoculation an d this opposition to a certain extentex ists tod ay.'? ' Sk eptical legisla tors could look toreputable, est eemed men wh o joined the ranks ofthe antivaccinators - men like George BernardShaw and F rederick Dou glass .v

Indeed , by usin g Kuhn 's paradigm thesis, it isclear that leg islators who finally supported compulsory vaccina tion wer e not necessarily enlighten ed souls who had glimpsed the truth of science.Rather, these legislators were actua lly ta king aleap of faith toward an empirica l world view.E ven a century after Jenner's Inquiry, no theoret ical explanation could conclusively buttress the

ar gument that vaccination was the only means torid the world of smallpox .

In 1799 Jen ne r h imself had offe red no theoretical explanatio n for his hypothesis that exposureto cowpox would protect humans against smallpox . Nor could Jenner's medical peers explainwhy vaccination with cow lymph (or inoculationwith live smallpox germs) protected humansagainst the disease. Creighton described thismedical assent to a mystery: "T he profession wereunwi lling to admit that there was any real mystery . T hey reasoned: we are practical men : it isnot our affair to explain how or why cowpoxwa rds off smallpox: but we know from our experiments that it does so, and that is enough for us." lJ

T he germ theory of Pasteur and Koch (1876)lent a scientific basis to vaccination, yet manyphysicians who espoused vaccination distrusted"exuberant imaginations ... about organicgerms."> Germ theory, more "wonderful than thevisions of Eastern fable ," clashed with dominanttheories of diseases as miasms stemming from atmospheric cond itions . Mor eover. vaccinating physicians did not cite Pasteur to support their case.P hysicians were reluctant even to pasteurizemilk. At the 1897 ga theri ng o f the MassachusettsAssociation of Boa rds of Health, only two doctorsspoke up for pasteurization - William Sedgwickof Ma ssach usett s a nd Chapin of Rhode Islan d.v

Empirical eviden ce by itself was not conclusive.Proponents and oppone nts of vacci nation ma rsha lled sta tistics on mo rtality an d morbidity. Onthe proponents' side, Cha pin to ld members of theGener al Assembl y: "In the Franco-P russ ian warthere were 316 death s from sma llpox in the wellvaccin at ed German arm y, and 23,469 in the poor ly-va ccinated French army," Darlin g counter edthat mortality differentials st em med (rom different conditio ns (f resh air for the Germans, crowded camps for the Frenc h) . Vaccination advocatespoint ed to declin in g smallpox mo rtality figures(rom London hospitals. T he opponents arg uedthat many wh o had contracted smallpox had infact been vacc inated. A report on High gate Hospital in 1871 noted: "Of the 950 cases of smallpox.870, or 91.5% have bee n vaccinated." As for deathtolls of unvaccinated people caused by smallpox,annvaccinators argued that eit he r examiningphysician s had overlooked vacci nation ma rks onseverely disfigured patients or that unscrupulous


physicia ns had misreported smallpox death s aserypseleas. a disease wit h similar sym ptoms. AnEnglish statistician. Alfred Wallace. concl udedthat vaccination had actually increased the incidence of smallpox.-

Evidence of the time linked vaccination withtetanus. lockjaw. cancer. syphilis. erypseleas. andleprosy." McDonald told Rhode Island legisla torsthat "cancer is incr easing as vaccination is mo reprevalent. A little girl in Woo nsock et was vaccinated last summer and got lockjaw. and I madeup my mind that none of my children should bevaccinated. Regular epidemics of lockjaw followvaccination...• One writer even blamed too th decay on vacc ination. noting that "if vaccinationan d the beginning of seco nd teeth are contem poraneous. deformity of the teeth may be the birthmark inflicted by vaccination.?"

Ant ivaccinators also declared that Jenner'swizardry had bred a new disease. variolus vsccinee. and that ma ny people died from the vaccineitself. In fac t. amid conflicting studies and report s,me n like McDon ald had good reasons not to endo rse compulsory vaccination for adults. One editorial. included in Sidney Ride r's collection ofnewspaper clippings. echoed the reservations ofjudicious legislators: " If there were no cases of injurious results followi ng vaccination the au thoriti es might regard parental objectio n to thatmethod of prevent ion from small pox as em anatin g from ignorance. But as these inj urious resultsare quite frequent. and often spring from causeswhich medical authorities cannot guard against.the power of school boards to close public schoolsto pupils whose pa rents object to vaccinationshould be exercised with caunon.v's

Discussin g the connection bet ween vacci na tionand an array of illnesses. so me writers blamed theidiocy of injecting "bovine matter" into humans.T h e anonymous author of a tract that Darl in g reprinted upheld the cause of "people who. even ifthey a re descended from gorillas. refuse to havetheir natures mixed ag ain with th e disease ofbeasts."? Before vaccination. physicians had con cocted remedies from animal matt er. but they applied these remedies to sick people. Vaccinationproponents sought to inject diseased pus of a cowinto healt hy people - an irrational proposa l tomany American s.

Empirical eviden ce offered by both sides was

less than conclusive even by scientific standardsof the time. The rudimentary typology of disease.the haphazard reporting of smallpox cas es. andthe low caliber of physicians made the evaluationof "scientific" data a form idable task. When Chapin investigated the 157 Providence cases ofsmallpox reported in 1902. he found only 48 genuine instances of the disease. P hysicians had mistaken varicella (30 cases). eczema (I 8 cases) •acne ( 14), vaccinia (3). insect bites (2). and a collecti on of ailments ran gin g from German measlesto poison ivy for smallpox." Such poor diagnosescast doubt on data routinely gathered by boa rdsof health.

The critical test for empirical evidence was theseverity and frequency of epidemics. Man y people.ho wever. were reluctan t to cred it cha nges in thefrequency of the disease to vaccination. Thoughsmallpox epidemics occurred throughout recorded history, no one cou ld conclusively predict whenand why an epidemic would occur. Vaccinationproponents cou ld not claim that vaccinati on haderad icated smallpox - the United States sufferedepidemi cs in 1871 an d 1888. Records suggestedthat even vaccinated people did not escape smallpox. In E nglan d. entivaccinators either ag reedwit h Alfr ed Marshall that vacc ination had exacerbated sma llpox or they conceded that the incidence of smallpox had declined, but they refusedto credit thi s dec line to vaccination . Dr. Farr , anEn glish physician. noted in an article on "VitalSta t ist ics" that "smallpox attained its maximumafter inoculation was introduced; this disease bega n to grow less fatal befo re vaccination was discovered; indicating. togethe r with the dimin ut ionin feve r, the general improvement in health thentakin g place.':"

Mod ern scientists can explain this conflictingdata that accounts for the rel uctance of manynineteenth-century Americans to ma ke a leap offaith. Unsa nitary met hods may indeed have killedpeopl e who had been vaccinated. Outbreaks ofcance r, leprosy . and syphilis wer e coinc idental tothe occu rrence of smallpox - assuming dia gnoseswere correc t in the first place. An alarming number of vaccinated Americans did contract smallpox; but where Da rling and his allies blamedvaccination, modem scie ntists blame im properlym ph . As early as 1889, Ed gar Crooksc hank, anAmerican writer. believed that farmers might


have diagnosed engorged udders as cowpox, andthat lymph from these cows could not guardagainst smallpox." Wh en state health departments began to supervise lymph production andlicensed physicians began to administer the vaccinations, the number of "vaccination tragedies" diminished,

Neither a statistican nor a scientist, Darlingdisapproved of malandrinum and sulf ur as muchas he did vaccination . He was a toolmaker whoshared a preva lent skepticism of medical science,especia lly s ince this science emanated from acompet itive array of healers, all of whom stood topro fit from their sundry cu res. If Da rling and other ant ivaccinators had simp ly pr eached that vaccina tion was another medical idiocy , theircampaign woul d not represent a paradigmaticrevolu tion, Darling, however, was advocating another solution to disease - sanitation.

His torians point to a go lden age of sanitation.when people at las t recognized that contaminatedfood , dirty streets, crowded houses. and pollutedwater cou ld ma ke people ill. and that these couldbe eliminated as breeding grounds of disease. Doctors Snow and Chapin were sanitarians who issued innumerable reports to the P rovidence citycouncil on " Nuisa nce of Soap Works," "The Practice of Converting Wells into Cesspools," "Removin g Night Soil,""Adult eration of Milk," and"Swill an d House Ottat.':" By 1900, thoug h, Chapin was deserting the ranks of ort hodox sanitarian s. Ahead of his peers, Chapin recognized tha tbeyond minimum levels of water, food . and air purity. sanitary im prov em ents would no t improv ehealt h. He looked for defective plumb in g, filthyvaults. and ga rbage-str ewn yards in the homes ofpa tients, and he found no significa nt correlat ionbetween sanitary conditio ns and th e presence ofsca rlet fev er. diptheria an d typhoid fever, Whilehealth departments throughout the nation wer ebattli ng disease wit h quarantine. iso lation. and fumigation ordinances, Chapin gradually relaxedsuch measures in Providence. He recognized tha tgerms, not filth . caused disease. and that sanitarymeasures improved municipal comfort mo re thanhealth.

Chapin. how ever, was "all but alone amongsanitarians befo re 1900 in believing that gen eralfilthy cond itions had no causative relation to disease." Sanitarians credited improved health statis-

tics with improved sanitation , and evenenlightened people assumed that smallpox wouldrespond like Asiatic cholera, typhoid. and diptheria to sanitary measures." Darling was a sanitarian who saw vaccination and sanitation as competitive techniques. He feared that enthusiasmover vaccination would divert public health officials from effective disease prevention. WhileChapin continued to provide regular and free public vaccination clinics. Darling to ld the GeneralAssem bly that "smallpox is an easy disease tocu re by sanitary rreatrnem.':"

Sanitarian s. mo reover, feared that people eage r to em brace this sa fe, sure, prophylaxis wouldlapse into "the sloth and carelessness to wh ich ordin ary humanity is prone. The pract ice of vaccination is now re garded by many of the forem ostsanitarians of the world as an irrational attem ptto beat outraged natur e - a futile effo rt to avoida zymotic disease without getting rid of the condit ions o f uncleanliness out of which it springs. andby wh ich it is propagated.?" As a result, sanitarians supported government regula tion of st reets,cesspools, housing. water , and food. Even libertarians conceded that government could dictateminimal levels of cleanliness to individual citizens. T he argument for vacc ination carried nosuch force, for if vaccination truly immunizedagainst smallpox. then those protected would notneed to fear contagion from unvaccinated neighbors. As regular phys icians preached their "heroics" and irregulars preached their chemicals,sanitarians proposed an en lig htened alternative:"Wh en the medical profession of today getthrough with their pett y squabbles an d jea lousiesand their silly specula tions with the theoreticalmicrobes of diptheria , phth isis, cho lera, etc., it isto be hoped they will turn thei r attention to thepositive microbes of bad diet. bad venti lation. badhomes, an d bad habits which invite disease an dshonen hu man life." 'O'j

Aft er 1900. however, sanitarians became lessfea rful of vaccination efforts. Perhaps becausethey reco gnized that health departments werecommitted to housing . food . and water regulation.or because they reco gnized the merits of vaccination. some antivaccinators were ma king the leapof fa ith into the ranks led by Chapin. T hose whohad formerly argued that "cleanliness is the onlynatural hen ce scientific protection from filth dis-

121 SMALLPOX VA.CCINA.TION

ease" came to accept a compromise explanationfor smallpox. one that reconciled cleanliness withvaccination. Smallpox. they conceded. might begin with a " germ." but that germ flourished infilth . As Dr. Friedrich. head of Cleveland's Department o f Health. explained: "Smallpox ... is afilth disease and is spread by a definite microbethat flourishes in unsanitary places.vw Dr. F riedrich was wron g. but his logic reassured sanitarian s that public health depa rt ments. eve n wh ile

they waged vaccination campaigns. would continue to stress municipal cleanliness.

Wh ile Darling and his sanitarian allies delivered antivaccination speeches and wrote countlesspamphlets to communicate th eir point of view.their campaign influenced many people who wereneithe r committed to heroic med icine nor to sanitary science. Some saw the issue of vaccinat ion asa medical problem with im portant polit ica l overtones. Representati ve Morgan . for instance. ob-


jeered not to vaccination but to the compulsorylegislation that limited freedom of choice, Similarly. Representative Archambault believed compulsory vaccination meant state interference in alocal concern. One newspaper editor suggestedthat state control over lymph preparation hintedof socialism (but the ed itor endorsed compulsoryvaccination nonetheless).

For these men. as for others, compulsion raisedthe specter of a threat to liberty, a threat to a society they cherished. Although immigration, industrialization, and urbanization had changed theeighteeruh-ceneury village and town. manyAmericans - especially older Americans. likeDarling. who had been reared on farms - retained a village ethos. Like their forebears. theybelieved in coo peration. fairness. education andmoral responsibility; they distrusted large monopolistic corporations, foreign-speaking immigrantswho worked in impersonal factories . and the rapidly emerging cadre of medical experts whoclaimed to understand health more than ordinarycit izens. Village Americans did not want government dictating to them. Sidney Rider succinctl yexpressed this attitude when he WTOte that "legislat ion has produced more misery. both in Englandand in the United States. than all the other causesof misery combined." He perceived "t he greatestdanger to the people lies not in themselves, but inthose to whom they have delegated the power oflegislation .USl

Until 1878 local health boards in Rhode Islandfunctioned autonomously. without state direction:until 1881 these boards used education. not compulsion, to encourage vaccination. Advocates andopponents alike hoped publicity would aid theircause, In 1859 even Edwin Snow opposed compulsory vaccination , preferring to appeal to people's" good sense: ' Antivaccinators were not seekingto outlaw vaccination, but they were determinedto outlaw its com pulsion. Frederick Douglass observed: "I am with you in your opposition to compulsory vaccination .... I am for the largestliberty of thought and conduct this side of crime. Iam no mo re in favor of such powe r when wie ldedby a majority than when by an individual.vv

Education versus coercion. Sanitation ver susvaccination . Samuel Darling versus Charles Chapin. In the 1890s, the two pa radigms clashed, Cha pin saw men set in a bureaucratic societydependent upon experts for advice and direction .Physicians were not a motley crew o f competinghealers but professionals offering expertise: government regulations, however they might impinge upon individual liberties. en hanced thelarger public good. Chapin dismissed Darling 'sconception of independent men regulating theirlives and their health without expertise or governmental direction. Darling. in turn. dismissed Chapin 's technocratic society, with its pretensions ofmedical expertise and its bureaucrats "hoodwinked by doctorcraft."

Government might presume to dictate to peepte. but it acted with the guidance of trained helpers. When Darling asked Mayor Doyle ofProvidence why he believed in vaccination, Doylereplied that he "had perfect confidence in Dr.Snow." Medicine. once the butt of Dr . Oliver wendell Holmes's humor, became serious and respectable. Physicians who had been formerly dividedinto competitive camps of regulars and irregularsregrouped into accredited licensed practitionersand the nonaccredited, illegal "quacks:' Compulsory legislat ion in most states required that licensed, certified or registered physicians signvaccination certificates or certificates showingthat a child was "un fit" for vaccination . Rhode Island's 1881 law stipulated that "practic ing" physicians had to vaccinate school children; by 1896."practicing" had been changed to "licensed." Irregulars rebelled against this government interference. Compulsory vaccination alone might nothave unseated the assortment of irregulars. but itgained acceptance at the same time as licensingand registration requirements did . Th rty statesby 1898 required physician s to pass qualifying examinations, nine states (including Rhode Island)accepted diplomas from certain schools in place ofan examination . six states required only a diploma. and five states had no restrictions.v

Local health boards began as citizen boards designed to augment town councils. By 1885 medicalprofessionals sat on those bcerds.> The transitionof authority. as citizens yielded to "experts," angered amivaccinators. Samuel Darling and Sidney Rider argued against arbitrary governmental

123 SMALLPOX VACCI N ATION

e-dicts that made- the- pret ensions of medicine intolaw, but their prote-sts cou ld not stop the risin gtide of re liance-on profe-ssionalism.

Ind e-e-d, the antivaccinators were- simply out ofplace in the- twentieth century. T hey had beenreared in an era of sanitary reform whe n ration almen had extolled cleanliness as the mod ern successor to witchcraft. priestcraft and doctorcra n,The- antivaccinators by 1900 were old me-nclinging desperately to old ideas. T he- ne-w paradigmbrought in younger men schooled in ge-rm theoryand reared in a bure-aucratic society that functioned under the aegis of governmental regulations. Unsurprisingly. the new professionalsthought the antivaccinauonists were nothingmore- than misguided quacks.

1 Robt-n Menon, "Science and Dnnocntic Social Struetlll"e. SacUl Tht'Ot)' vtd SocW Srructure(N,.. York. 19681.612,

2 William Jmnn. "Inqwry im o the C..llWS and Effeeu ollheVariobe VKcine in COW-POCk." 1199; HUT)' W;ain. A HistoryofPre..enf' ..e Ml!'dicilH'(Spri n Clield. til.. 1970). 196

1 Lloyd H &njamin W;arerhouse. M .D. (Bos ton. 1975), 41;William Tr;a Hmnrd. Public He../lh Adm",inratKtn MId theNarural HislOf)' 01Diu.... in Baltimore. Maryl..nd '7'97-1920(W;aahinglon.I9241. Soli,

4 Wa>n. HlSforyof Prevemive Medicllle, 191;George Rosen.H istory of Public lIe../rh (New York, 19.508). 183--190; J..m... H.CUKdy, Ch..rl... V, Chapin and rhe Puhlic Healrh Mo..em enf(c..mbridge, I962).1IO.

5 Thoma.. Kuhn. Th e S'TUcture of St:iemific Revolu rion~ (Chi_rago, 1970).

Ii "Samuel Dar ling," Proridern:e; Ir6 Life ..nd Indu~ rri", n,p..n,d.. on e pa~e. RIHS Library: Pro ..idence joum/lL Oct. 13, 1896.

7 R hode bland Acr. and Reso l lres, J..nuary- May 18111 ( Provi.dence, 18lI1), 127.

8 "Our experience in deahne wilh rhe pte...nr epid emic compelsu.s to place isol..tion be/ore ..;accin;ation. T he La u er has no l""'emed to alford Ihat prorenion Which h.u ........Uy been ascribedto it. At panicuLu stae'" 01 the epidemic this ;agency did not ar rest lhe proefnll of th e di"",a"",as"'as elfpcctcd Neil her in individ ....l ca..... hu it pre"enled penon, apparently ...ellvKcin;atcd from hiving e viotem, ;and in "",veral ilUl!allcee, ;a f..ulau ..ck ollhe smallpox," Lowell Board of Hellth and of C0nsulting P hysicians. Smallpox In LcwclL as ;accepted by Ihe CityCOllncil. December 12. 1171 (Providence. 1891). ll, Rider Colle<:lion. John H ay Ubrary. Brown Uni"erli!)' .

9 Jon&ltun Pickering. An A~ before the judicWy Comminnol the ~M'~ in 'he Sr.. ,~ H~. Apri l 20. 1894 (Providence. 189") ; Samuel D;arlin&:. V.acrinottion.. Gicantic Crime.The G""I~ F ra ud ever Perpctr.. rl!'dupon the Ho»n.tn R~.tnd

Prep06reroua lkyond Dcsc-npcion (Providence, 1896). I ; Darlingto the Honorable Mem bers o f the General AMcmbly, n.d .• R iderColi .

10 Darling 10 the Honorlble Members of the General Ase.cmbly.n.d.• Ride r CoIl.

II BooJr Nat.... lIOlurnn Ilhrough XXXII. conUin ref er ences 10antivac.:in.ation concern",-~ spe<:ifically. lV, 70; XVI I. 164;XVIII. 93. til. XIX. 89; XX , 84. 116; XXVlll20, 164. 189: XXI X,IS; X XX.6J, 107; XXXII. lOB

IZ Uona.rd to Rider. M;ay 10, 1901. R,der CoIL

13 Benjamin Wlure. Small..... .tnd V.aawnon (Cambridee.192.\).69-71 : D&rlinC to Ihe Honor;able Mem bcn of lhe GmeralA.crnbly. n.d-. R,der CoII~ Providence}ourn.tl. Oc-t. 13. 1896.

14 D..rhng ....med Ihe edlton 01 rwenty-five Rhode 1sIand n.......papcn and cited an interri,.. hc-twCfl>;a repone' from onenewspaper. The News. and. Dr. Chapin on lhe ql>CStion of compuLaory lell:ialItion, _hen Dr. Ch&pin declared, -I aha1I never iIdVOCIU its repeal mys.clf but I do think Ih&t .. fter all il Os lh e benlhinC that could happen , So Ionll:as Ihe La... ~,ns on lhe SUtute booIr th:" IciUlIJon will be pcnir;led in and lh .. l iII ..pt toalien,ue Ihe people Irom their ootlVK1..... th ..t va.ccin&t>on is aIl:ood thinll: . ~ Dvling. V.acn....'lOft.l.

IS Rhode bla.nd General La_ 1896. Chaopter 65, Section 14;MaMlC hllHlts SUI,u lesoll894. Chapter 515. Sc<:tion 1. R hod elaland did noo: adopt ,hia unfiln.... cI....... until19lS. Public La_01 Rhode Island Janu&ry 191.\, Ch..pter 1201.

11 G.ordner SWaM, Scc rc-UIry, Ann....1 Report of 'he Board ofH e.. lrh of Rhode la/an d 1899. 108. In ubul.. tin g "Pr-e..alence ofIllmport;ant Acure Dise-. 18lI4to 1888." th e Board 0 1 H ea lthdid not include smalJpolI. Charles F isher . Secretary. Annual Report of rhe &>ardof Healr/!, 1811. \2.21.

18 In 1888 Charlestown re poned "no loca lio n in lown panicular_ly un heal lhy; no nuiNne" da nge rous to the pu blic heal th withinmy knowlede e. ~ F isher . Annual Report of th e Board of Hea/t /!,1888, 105. In 1889 Eatt Greenwich reponed ;a..W1.....I ;amount ofge neral sickn.... during the past yea r." Fisher. Annual Reportof rhe &>ard of H ....lrh , 1889,17.

19 Fisher. AnnulIl Rep<:>M of rhe Hoard of Heal rh. l 8ll9, H'84;SwaMs, Annual Report of the Board ofH~a/rh. 1901, 11·50; Centrill Falls Report. 21.

20 F iaher. Annual Report o( rhe Stare Board ofH ealrh. 1890, 61Esrab hshed in City Hall and fin.. nced through G;an:lner S"'U tl'S

own ba.ckine. Ihe Providence HCl lth De pan me nt 's Bact eriolog_ical Labor-alory wu th ~ first such l;aboratory in the UnitedS tatn. Caucdy, Ch~rl... Chapin. 55

21 Dr. Chapin ubul.. red the total number 01pcnons ..;acci.... tedyearly in P rovidence Ilince 18.\6. Swaru. Ann....1R eport of theBoard 01 H e..lr/!, 1901. 76.

12 Sw..ru, Ann....1Report of ,he Boardof Hellr/!, 1901.147; Ca ..sedy, Ch..pin. 6J.

23 -Subfti'ure Bill A." Rider CoIl.; Providenc-c}ovrnal Apr . 4.1901.

124 SMALLPOX V ACCI N ATIO N

25 H owar d FrumkIn. (io.wmm..nl of H ...lrh : Th .. Form. rion ofrh.. R1Kxk bland S,. r.. Boardof H ..alrh(Providm<:e. 1971) .;?9.lO; Chari.... Hempel.~. and trans.• Dr. Franz HMT-rrnlnn"s DU-...-ofChild....n and Th..ir Hom ftJf» thic T.....'m..nl (NowYor k. IIU3l. 439-<1 52; Fr.nk K raft..~Vaccination Vae.lies,- Th ..M<'d>c~ Advan.;«. X XIII (july 1889). 36-39". Darline. Vaccina ricn, 9. Frumkin defin.... r"rular phyaicians as Ih..... who beIone~ to ,he Me'dica l Sonny Frumkin. (io.wmmffl' of Hw ,h,ze

26 D.rlinC. Vacrina,ion, 8-1$ . Hmry Strickland ConsuMe, Exuacu from Our M Nlicin.. M en . nd Fair.... 01 rhe Day in M...diciM and SOenc<,. Vaccina,ioo and Vi"-«tioo (Provi<:k~.

1892)_23; J>nwtd.~)ownaL Apr. 4. 1902.

Zll Conauble cakulal~ that Irom IMI to 1171 public vaccinatonin Eveland had bHn paid OV<'I" one milbm~ from M'I

r.lee. Furthermore. he eakulat~ that if vaccination te<:hniqun.-.e~ for the eiCht oth... qmotK dis<'_ vaccinatonwould profit more Corm.Me. Entaet:l, 8. Darline wrote that in• KTtIllpoI pamc.t Eaton. Eneland.. sinell' doctor pocket~twO thouaand dolla~ for vKC;natinc 800 lIIudettu. Darline. VIC'"cinaIJOn. 8

19 Cormable. Exlfaeta, 4. Da rline. VaaTnalion, 12; J. W, Court·ney. &njMnin W.rer~. M.D .: Am..ric"" Pk>n«t'(Gfll..va.19 26). 7.

10 Ch.r1.... C...iehton. J..nner and Vaccin.,m, A S"ang.. Ctw~r..t in M<'dk . l H tstoq (P rovKI..ne ... 18'\12): Darline. Va«in.. rion,..

31 DoN.ld Ch u.rthill. ~U"tory of Smallpoll in Rhodl' Island. ~Provid..ne.. M <'d,,,..l JoomaL VIII ( 1902). Ill.

J2 S porakine bl' fore th .. Si"th AnnUol I Conferenc e o f lh e IrishAnlivaronat ion lA.eu" , G<"Ofee~mard Shaw d<"Clared that"the mel hoda of inoc ul. t ine child....n with casual dirt rnois, ..n<'dwith an un id..m ifi<'dpa lhoe..mc l u"tanC<' obta in<'dfrom ""Iv",[prov.... that ] vac"in. tion i. rull y nothing .hon of anempeedm utder.ri Rem. rlr.t origina lly r..pornd in Th.. Bn rish Medicalloom . I(l91 !) . SoU. cit<'din Haw ..... B..njamin W.'..r~ 50.For Do!.Jel...·• vi....... ~~ "ElI"trpt Irom lAUer to Prof. J. [)0bIOn . M .D,: · T"~l irrKJn i... AK.in~r lh .. V..ccin..'ion Fiend(Pro yjd..nce. 1892).31

J4 Quot<'din Howard Kr .m..r. "Th.. G..nn T h<'Of)'and the Ear lyPubli" Heahh P roe tam in th .. United Stat ....." Bullelin of ,h ..HiJlrory of MNlie;ne. XXII (19<111). 234.

3S Sci" OIifi" Am..ne.n. XXIV ( 11111). qlJOl~ in Kram... . "GermTheory." 234; Barba ra R....nkranrz. Public H....llh an d Ih..5""r..: Ch..nginc Vir .... in MUN<"h lts<'1 ... 1842·J9J6(Cambridee.1972). 1011,

J6 Chari.... C h.pin. Gardn... S ..... n&. and Wilham H. Palmer to,h~ H onorahle Membl'~ of Ih.. G..n...al ..........bly. n.d .. Rid,.,.Col i.: DMline . Vacci~rioo:t. 6; AJ..under Rc.. Tt1Ith~ AboutVacci n.tr ioo (Prowidenc ... 1892). II.: J. W. H odg ... ~Why Doo:-tonWho Vaccina l" S houl d Ahan don the PrloCtice. ~ M nJical A&.va.tJU. XL (1902) . 8'\1

37 Rota dubbed compul.ory vacc ination " D I...a~ by La w" andnou-d:"~lw~n th .. YU~ Ill)() and 188(1(in Can.da) dUlh.from "'Yphili$incteued 127 pe",ent; from blood poilOnine 100pe",..nl : from canc... 70 percent: from tabon m ......m ..ri"" 29perc..m : from 'kin d, ...."'" 109 perc ..nt. and Irom bronchiti. 1«perc..nt ." ROIl, Tt1Ilha. 36.

39 T..rribl.. Rnu/" of Vacet na rtoo by Emin..nr A urhors ( Provi·d..nee. 1892) .37.

4() Unciatll'<! nrwlp'P"'" "bppr:ne. Rider CoIl.

43 AlJr<'dM iln.... Vl('("tnauol'l an Error - 1" CompuJa;on.WrtJltC. (n.p.. n.d.) . 12. RKI.... Coll .

« How ard. Pubb<: H ..alth. 60: Edear Marc h CroolllChank. H~·

roryand P.lhokJcyof Vaccinariort (Phil.d..lphi.a. 1889). 196.

4S Repona 10 the City e-ncil of Providtnce. RIHS Library.CUNdy. Clupin, 94.

46 ea-dy. Cup",.94 Chari ROIet1ber e deuill1 th e transf....-nY lion in aUi ludft toward d from 1132 to 185 5. ....hen cityCOlinnmen", t'«Oenind Ihe Oftd for xani lary r..form- Chari....E . R.....nbn'c. Th .. ChoI..... Y..an (Chicaco and London. 1962).

47 Darl in e to Ih.. H onora bl.. M..mbl'~ of the Gen...al Asa..mbly•n.d.• Rider CoIl. Dar lin e _u " profou nd ly impr.....d .h... yta~ol~a",hinc inv....tiC.I>on. with the terrible ltuth th a I drugllhav .. no! only multiph<'ddi~asn but ilKTeased th..ir fatality andkill <'dmo.... th.n war. pntilmc~. and fam in.. rom bin<'d." Dar·hne . Vacci na lion, ItI.

48 Hod ge. "Why Docton Who Varona!e:' Medic. ' Adv2ItCeX L, 92.

SI Th .. R"p"hlic..n. n.d.•n..wtp;1per d ippin l[. Rider Coil.: SidneyRid..r , Book N O!..~. IV ( 18lI1), 70, Rob..n Wi..be poinu our th.1th.. Un itll'<! Slat ... in lh~ 18lIOt w•• st ill. vill.ge lIOCiety. Wiebe .Th .. S....rt:"h for Order (N ...... York. 1967 ).

S2 Ed win Snow. " R..pon on th.. Sm a llpo" in th<'City 01 P rovi·dence from J . nua ry to J un.. 11159." Ciry Docum"01 No. 4. 1851).1860.20-21.qUOlII'<! in Frumk in. Gov..m m" 01 ofHe..lrh, 62:Doug l " E llcl'rpr from Leiter ." Tesrimon i.... 31: Ho ....ard,Public H lrll. 96.

53 D. r lin e to H onor. ble Membl'~ ol th e Gell..ra.! Aatembly. n.d.,R id..r CoIl.; Abhon. Pu r .nd Prftf'nr Condition 01 Publi" Hy-gi..oe .ndS r.-t.. Moodki".. in I h.. Uni led Stal....

54 Abbott. Pur and Prftffll. 78 ,

125

Index 10 Volume 38, 1979

Abolit ion ists. Samuel Hopkins. ]l1-49Ada ms. Herbert, William E llery (h.mnlng bust. ilius;

48Akin. John. 3SAllen. John 8., family. 22Am erican Brass Band of Providence. inst ru ments, illus;

96American Homemakers. 29Anthony, Joseph. 35Anthropologica l Society , 88Anti-Catholicism. 51-62Antislavery mo vement. Samuel Hopkins. 39-49Appon.aug Print Wor ks. 23. 28; ilJus.. 13. ZOAquidneck Island settlement. 73. 75; l iege of Rhode

Islan d 19-85Archambault . Adelard. I J7-111

Band inst ruments. ilJus..96Ba ptists. T ivert on and religious liberty. 35-37Barnes. John. 68Barney, Adelia Merry, 12Barney. Charles w esley. Jr .. 22Bartl ett. Robert . 68Battl e of Rhode Island commemo ra tion. 24Beecher, Cathe rine. 8Bell , Luther , 100, 103-\ 04Bell Street Cha pel. 94Bible reading in schools. 94Billin gton. John. 67, 76Blackstone Man ufacturin g Company. 29Blackstone, William, 72Bonaparte, Napol eon, 113Borden, Richard, 35-36Bradf ord, William , 73, 76Brian, Thoma s, 68, 70Brown, John , 43, 47Brown, Mosn, 42~5 , 47; engravi ng . i/lus.. 43

Brown and Sharpe. 114Bryan . William Jennings. 57Bum s. F ran k. r r. 22Butler Hospital. Isaac Ray, 99-111; engraving. jJI~

pla n of. ilIus.. 105

Canonicus.. 67-72Carey, Magg ie. 22Catholic Press As.sociation. 53Chace. Elizabeth Buffum. 31Chafee, Zechariah. Jr.• S8Channing , William Ellery. 48; bust, i1IUs., 48Chapin. Charl es V.• 113, 116-22: portrait. il1us~ 121Chase , Constan t. W " 22Chase , Susan Slocum. 22Ch ild abuse, 91-92, 94-95Church an d state. T ivert on's fight for re ligious libert y,

3,S.37Church, N. B. family. i1Ius.. 15Churchill, Donald. 118Churc h of the Med ia tor. 94Churc h of the Precious Blood , Woonsocket. il/us~ 54Cla rk , Frank , 55Clarke. Ed ward Y.. 60Clarke . John. 35Clinton, Henry. 84Colonial Dames. 27Combe. George. 100Conforti joseph, "Samuel Hopk ins and the

Revolutiona ry Antislavery Movement.." 3(}.<49Congregatio nalism. T ivert on and religious liberty, 3,S.

37Consolidated Car Fender Co.. 23: office. ilJus., IIConstable, Henry. 117-18Cooke. John , 35Cooney, Edward J.. 53Creighton . Charles. 118Crookschank. Ed gar. 119Cross. Daniel, 68-70, 72-73. 7,S.76

Da in, Norman, 101Darl ing. Samuel. 114-22; port ra it , illus; 115Darling an d Swarts, 114Davis. Aro n, 35Davis. James J., 59D'Estaing, Comee, 7l}-35

Dix. Dorothy. 10.s.J06Doh en , Dorothy , 52

1

126 INDEX

Douglass. Frederick. 11 8Doyle, Th omas A.. mayor of Providence, 122DuBois. O. E .. 22;Church family. il/us., 15Ducharme. jacques. 53Dudley. Ida. 22Dun nigan. Kate. and Hel en Keba bian . Laura B. Roberts

and Maureen T aylor. "Working Women: Images ofWomen at Work in Rhode Island, 188().1925." 3-22

Eddy, Samuel. 68Edwards, Jonathan. 39; port rait, iI/us.•40Edwards. Jonathan . Jr ., 44. 47Ellis. john Tracy, 57Energy conservation, 89. 94Environmental protection. 88. 94Equal rights. 91-92, 95Esquirol. jean Etienne Dominique, 100

Fabre Line vessel s. ilIus.• 59Family: living room . illus., 6: mother and child, illus., 8:

rural family , illus~ ISFa rr , o-, 119Feminists, working women. 3·22Friedrich, Dr., 121Friends ' Asylum. 101

Gall . Franz j , 100-101Garvin, Luciu s, 88Gaspee House, sale , 24Gersuny. Ca rl. "j ohn Francis Smith, Heterodox Yankee

Printer," 87-95Gibbons. James Cardinal, 52-53. 55; iIJus~ 50Gold, Daniel. 35Grand Army of the Republic Auxiliary. 29Grant. Madison. 51Greene, John. 72Greene, Nathanael, 26

Hahnemann Society of Homeopathic Physicians, 117Hamilton. Alexander. letters. 26. 29Harris, W. j., M05es Brown engraving, il/us~ 44Hart, Levi . 44....5. 47Hart, Samuel, 100Hartmann. Franz, 117Hawthorne, Nathaniel, 100Haying scene, iIlus~ 2Hazard, Thomas, 106-107H ickey. Bishop William, portrait , ill us. 58Higham. john, 51

Holmes, Oliver Wendell. Sr.. 117-18, 122Holt. Anthony. 79Holy Gh05t Church mutual aid society parade, il/us.• 56Hom e Publishing Compan y, 88Hopkins, E lizabeth. 69Hopkins, Samuel, portrait , mus" 38: "Samuel Hopk ins

and the Revolutionary Antislave ry Movement ," 3949

Hopkins, Stephen, 31, 69Hcrham, Commodore. 84Howard farm, Cranston, 100Howe. William. 82Howland. John. 31Howland. Nathaniel. 35Hunt, Samuel. 36-37Hutchinson, An ne. 35

Immigrant woman. ilIus.• 17Indian, murder of, 67-77Insane. care for and Isaac Ray. 99-111Ireland, john, 52

jackson, Kenneth, 60jackson, Thomas. 68-70, 72-73, 75-77jacobs. Fred, "Isaac Ray and the Profession of

Psychiatry," 99-111james, Sydney, 28james, Thomas. 72. 76j efferso n, Thomas. 11 3j enner, William . 113-14, 117-19j ewelry manufacturing, 23: iltus; 19J. F . Smith Printing Company. 88Johnson, Mary. 22; illus.; 16

Kebablan. Helen: see Dunnigan, KateKnights of Labor, 12.88,94Koch. Robert. 118Koopman, Harry Lyman. 94Kr aft. Frank. 11 7Kuhn. Thomas, 114, 118Ku Klux Klan . Catholicism . 51-62; mus., 60

Labor, john Francis Smi th . 88-91LaFantasie, Glenn W.•"Murder of an Ind ian , 1638," 67·

77League of National Unity, 52League of Nations, 53Leonard. Samuel. 115Lippitt, Charles Warren. family , mus.• 21

127 INDEX

Literacy tn ts. 57-58Loew's State Theater, 28London Anti-Vaccination Society, 114Longfellow, Henry Wad.!lwonh. 100Lord. Avery, 22; Mount Hope Bridge construction.

iltus; 6J...64

Ma C<:auley , Clay. 94McDonald, Joseph, 117-19McEl roy . Bill, 21, 22McGuire, E. C., 59McLean Asy lum . 101Mcloughlin, William G., "Tiverton's Fight for

Rel igioUli Liberty, 1692-724," 35-37McVicar, Sa ra h. 22Maine Insane Hospi ta l. 101-102Mars h. Joseph , 36-37Marshall. Alfred. 119Marshall, Frank Warr en, 22; haying scene, illus .;2;

Slater Avenue school, ilJus. 9Marx. E leanor. 87, 94Ma rx, Ka rl, 87Massasoi t. 68. 76Mather, Cotton, 37Medicine: and paychiatry, Isaac Ray, 99-111; smallpox

vacc ination. 113-23Mendlow, Will. 69-70Menta l health, Isaac Ray, 99-111Me rt on , Robert. 113-14Miam onorni. 72-73, 75Milla r, John F, ( ed.), " A British Account of the Siege of

Rhode Island 1778," 79-35Missionary Society of Rhode Island. 48Mixanno, 67-68Moma gu, Mary.l 13Mor gan, Will iam, 117, 121Morse (Morss), John, 35Mosier (MOIiher), Hugh. 35Mott, Jaco b. 35Mount Hope Bridge, 63; i/lus. 63-64Mueller . F rederick J., 23; cig ar store, illus. 14Mu mford , Jo hn, T iverton map, iIlus.,34Murder, Indian mu rdered. 67·77Museum of Rhode Island H isto ry, 28Myers. Sarah Ann a, 87

Narra gansett Indians. murde r, 67-77Nativism, Catholicism, 51-62Newell, J. P" Newport F irs t Congregational Church,

iIlus.... 46Newpon. Firs t Congregational Church , illus.. 46; siege

of Rhode Island. 1778, 79-85; map. ilJus., 78Newport Herald. 44N ewport MC'rt"ury. 43, 105

New Yor k Abolition Society, 4.....5. 47Neck, Mary , 79

Ogden, John. 117Olney, Jeremiah. 29Ounne, Pierre, Siege of Rhode Island. il/us.... front. No.

3; iIlus.... 81, 84

Pade n, A. J., 60Paine, T homas D., woodwind instruments. illus.96Partrid ge, Thomas, 37Paste ur , Louis, 118Peach , Arthur, 68-73, 75-76Pease, Albert L., 23Penowanyanquis.68-77Pequot fort , 74-75The Peopte, 88. 91, 94Perkins. Charln. 30P erry, Oliver Hazard. 26Picker in g, Jona than, 114Pickering, Theophilus, 37Pierce , Edwin C. 94Pi got. Robert. SJPinel. Phillipe, 101P lymouth and Provi dence, unchartered territory, 1638,

map, il1us.. 66Prenee, Thomas. 75Providence Female Cha ritable Society, 29Providence Gueul!' and Coun try jOfJfflaL 44Providence joumiiL 107, 11 7Providence Menta l Health Center , 110P rovidence Riidica l Club. 88, 94Provide nce Society for the Abolit ion of the Slave

Trad e, 47Providence Visitor, "T he Providence Visitor and

Na tivist Issues, 1916-1924", Sl -62

Quakers, me ntal health , 100-101. 104; T iverton andreligious liberty, 35-37

Ran ger, Walter, 55Ra WlOn Founta in Society. 29Ray, Isaac, " Isaac Ray and th l!' Profeuion of

P, ychia try ," 99-111; portrait, ilJus.. 98Reina, John Perer , siege of Rhode Island, 79-85Reina, P eter An th on y, 79Re ina , Sarah, 79Re ligion: Catholieum and nativism. 51-62; John Francis

Smith, 92-94; Ti verton ', fight fOfreligiow.liberty,35-37

128 INDEX

Rets inas, joan, "Smallpox Vaccination: A Leap ofFaith:' 113·23

Revolutionary WiU, siege of Rhode Island. 79-85Rhode bland Historical Society, officers, 31-32; one

hundred and fiftYoS~v~nthannual me-eting. 24-32:property sales, 24; reports of: director, 25-27;educ.ation departmem. 27·28; librarian, 28-29:museum st.aff and activities. 29-31 ; president, 24;treasurer. 25; special meeting, 24

Rhode lsl.and Cemral Labor Union, 87. 94Rhode Island Hoapital. illus... front, No. 4: children's

ward, 23; illus.. 10Rhode Island Stat~ Asylum for the Incurable Insane.

110Rhode Island Stare Emplcymeru A5.suranc~League.

88.90Rhodes. Clementine. 22Rider. Sidney S.• 115-16. 118-19. 122Roberts. Laura: 5H' Dunnigan. KateRockefeller. Nelson Aldrich. 24Rccsevett. Theodore. 91Rothman. David. 99. 108Royal Weaving Company. 23; il/us... front. No. I ; il/us...

5: illlU.. 18Rural family , jJIU51 15

Saints Peter and Paul Cathedral. illus.. front .• No. 2Sawyer. john R..I09Sedgwick. William. 1111Siege of Rhode Island. illus.. front. No. 3; illus..42.84:

F rench fleet. il/us.. 81Selleck. Willar d C.. 94Shattuck. George Cheyne. 100Shaw, George Ber nard, 118Sheffield. Amos, 35Sim mons, Abraham. lotiSimmons, William j .. 60Sisson, john 35Slater Avenue school, 23: illus., 9Slavery. Samuel Hopkin s. 39-49Sm allpox vaccination, 11 3-23; broa dside. iIlus., 112Sm ith, Alfr~d E., 57, 61Smith. Celinda Rounds. 87Smith. De liver ance. 35-36Smith. George. 88Smith. j essie, 88Smi th. john, 87Sm ith. j ohn Francis. "john F rancis Smith. He terodox

Yankee Printe r: ' 87-95; Is the Universe Governedby a VeviJ?," cover, il1us1 92; an d son, tintype.iJ/us.. 86

Snow. Edwin, 113.120. 122Spencer. Anna GiUlin, 94Spencer, Herbert . 90Springfield Repu blican. 87Spurzheim. j. G.. I()().IOIStiles. En- ill, 4H 2

Stinnings. Richard. 68-70. 72-73. 75-76Stowe, Harriet Beecher. 48Sum ner, William Graham. 90Swan. Bradford F.. 27. 29

Taber. Thomas. Jr..35, 37Tabor. Philip. 35T albot, C. N., family servant, ilJus.. 16Taxation, Tiverton and religious liberty. 35-37Taylor. Maur« n: see Dunnigan. KateTemple, Dorothy, 69Thayer. Simeon. 29Thomas. Donna. "T he Providence Visjrorand Nativist

IAlues. 1916-1924." 51-62Tiverton, map. ilJus... 34: religious liberty. fight for, 35-

31Todd. Eli. 101La Tribune. 53-S4Tucker. john. 15Turke, William, I()().IOI. 104Tyler. Elizabeth. 60

Unempl oyment. 88-90

Vaccination, smallpox. 113-23

Wallace, Alfred. 119Wampanoa g Indians. 68Want on , j ose ph . 35-36w at erh ous e, Benjam in, 113. 118Wh ite , William Allen. 60Whitti~r, john Gre enl eaf , 48Wilcox, Steph en, 35Wilkinson family, 22: home scene. W us.. 7Williams, Roger . 26-27, 31. 35: eng raving. crossi ng

Blackston e River. ilIus.. 71Winslow , Edward , 68-69; portrai t. mus..69Wint hrop. j ohn, 69. 72·73. 75: portrait. jJJus~ 73Women . work ing women, 3-22Wom en's Christ ian T emperance Union. 29Wom en's Liberation Un ion. 29Worcester Hospita l. 102Wym an. Rufus, 101

You ng Men's Christian Associa oon. 56

A Gift for the Future

T he Board of Trustees of the Rh ode Island Historica l Society would like you to consider ma king theSociety a beneficia ry wh en yo u are preparin g your will. Such a bequest would help insure the Society's continuing efforts to collect, preserve, protect and interpret R hode Islan d's unique heritage. Abequest to the Society is truly a girt to future generations of Rhode Islanders so that they may sharein the Society's services and programs..

Should you desire to include the Society as a beneficiary of an unrestricted bequest when preparing your will, the following wording is suggest ed :

I give and bequeeth fa The Rhode Island Hisxaricsl Society in Providence in the State of RhodeIs land and Providence Plantarions. doJlars ($ ) . for its general uses and purposes.

The Director of the Soci ety will be happy to discuss this matter wit h you . Gifts to the Society aredeductible from federa l estate and income taxes.

T he Rh ode Island Historica l Society52 Pow er St reet

Providence. Rhode Island 02906(401) 331·8575

OD LA D HI TORY · lum] would correct within its restricted domain °Mr.Jacobi., a lTadua,~of Brown Un,v,""y."a S,ucknl a, Cor n~lI ""'wSchool. by FredJacobs 0 the faults of the communityand

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