Founding Fathers Faced Health Care Revolt, Too
NEAL CONAN, host:
When a hot-button debate arises on religion, privacy, gun rights, some on both sides inevitably list the Founding Fathers among their supporters. But no so much on health care. After all, colonial Americans did not know anything about germs or viruses, and very few ever saw a doctor. But in a story in the Boston Globe, doctoral student Andrew Wehrman suggests that public health was a vital issue in an America that faced smallpox and yellow fever.
He tells the story of a group of men from the Massachusetts town of Marblehead who burned down the town's brand-new hospital to protest the high price of health care. If you have questions about health care in early America, give us a call: 800-989-8255. Email us: firstname.lastname@example.org.
Andrew Wehrman joins us now from the studios at Chicago Public Radio. He's a doctoral student at Northwestern. And it's nice to have you on TALK OF THE NATION today.
Mr. ANDREW WEHRMAN (Author, "A Pox On You"): Hi. Thank you, Neal. It's good to be here.
CONAN: And your story begins on a blustery January night in 1774, just a month after the infamous Boston Tea Party.
Mr. WEHRMAN: Yes. Well, a group of angry sailors of about 20 rode out to the inoculation hospital. It was built on islands to keep infection down. They rode out with buckets of tar and torches and they burned the place to the ground. It had been empty for a bit, but it will still cause considerable shock and distraction.
CONAN: Andrew Wehrman, why would people down a perfectly good, brand new hospital?
Mr. WEHRMAN: They burned it down because they didn't have access to health care, to smallpox inoculations. The town built the hospital. It was built privately by four gentlemen, one of whom was Elbridge Gerry, who would become a future vice-president of the United States.
They built the hospital, they provided a high-priced inoculator from New Hampshire to oversee the inoculations, and it drove the price of inoculations up to five pounds and 15 Schillings per person which would have been, you know, for an average sailor, for instance, to have his family inoculated, will have cost more than he could earn in a year.
CONAN: So they're ridiculously high price of health care in the face of a virulent disease like smallpox. And we should understand, this inoculation, this was the so-called live virus inoculation well before the time of Edward Jenner about 40 years later. And so, this involved getting a small degree of the disease and it would make you immune to it after that. But nevertheless, he could still communicate the disease for a little while.
Mr. WEHRMAN: Right. It was remarkably effective. But while you're undergoing the process, you're infectious for about three weeks or so. And during that time, you could spread live smallpox, what they call the natural smallpox, to others and start, you know, separate epidemics. So, people were always worried about those. But the potential for the cure was growing, an optimism was growing, and more and more people were wanting it especially towards the revolution.
CONAN: Indeed. At one point, it's interesting you had the suite recently decided by some people who did not - soldiers who did not want to take the anthrax vaccine. George Washington had his entire army inoculated.
Mr. WEHRMAN: He did. He was responding to the same epidemic that Marblehead folks were getting upset about. He was seeing troops dying of smallpox. The invasion of Canada failed largely because of smallpox breaking out amongst troops. And troops had begun to inoculate themselves on the side, which made, sort of, matters worse. Troops were - potential soldiers were refusing to enlist because smallpox was so bad in the army. So, it left George Washington, in some degree, a little choice.
But to his credit, he announced secretly the inoculation of troops. He didn't want the British to get wind that American troops were sort of ill-health.
CONAN: Suffering because it may it vulnerable to an attack.
Mr. WEHRMAN: Right.
CONAN: Yeah. This debate is fascinating because we think of this as a very loosely connected group of communities, but nevertheless, when you have something like a small pox or yellow fever, which later ran rampage through Philadelphia and other ports, the government almost has to become involved.
Mr. WEHRMAN: Yeah. They were a loose confederation of colonies, of towns, and then later, of states. And health care in colonial America, if we can even call it that, was a local issue, a community issue that was based on English systems that gave communities the responsibility to care for their towns. And mostly, we call these measures sort of sanitation, you know, make sure that outhouses were dug deep enough, keep that animals off the streets and that sort of thing. But the invention or discovery of inoculation changed that to a degree so that there was this cure that was expensive. You know, most of the time, a doctor would provide it, and it became a question of who pays for those. Do people do it on themselves? Should we do it privately? Or do local governments or colonial legislatures, or later, the federal government - who should provide these things.
CONAN: Let's get some callers in on the conversation. Alex(ph) is calling from Fairview Park in Ohio. Alex, are you there?
ALEX (Caller): Yeah.
CONAN: Go ahead. You're on the air.
ALEX: Oh, I was just wondering if with all these uprisings, like the burned down hospital, because the prices are too much, at what point do the government decide not to regulate health care? (Unintelligible).
Mr. WEHRMAN: Well, they did. They took some measures. Three years after the sailors burned down the hospital in Marblehead, the town voted when small pox came in again, they voted not to build a new private inoculation hospital. They voted to inoculate everyone in the town, whoever was willing. They brought in a doctor and a team of nurses and swept through the town, door-to-door to do inoculations.
CONAN: And they did this at public expense.
Mr. WEHRMAN: And they do it at public expense. Other towns had other solutions that sort of mixed public and private funds. So they didn't decide at this point, but it wasn't a government responsibility.
CONAN: Thanks, Alex.
ALEX: You're welcome.
CONAN: Bye-bye. Let's go next to Arthur(ph). Arthur with us from Little Rock.
ARTHUR (Caller): Hi. My question to your guest today is, after the failure of the Articles of Confederation during the Second Continental Congress, was there any discussion among the delegates, either private or public, on whether health care should be included in our new Constitution?
Mr. WEHRMAN: Yeah. Hi, Alex. Thanks for the question. The small pox epidemic fades at the end of the war has troops stopped moving around, and they stopped spreading the virus quite so much. And the community has kind of have to figure out how they want to rebuild their towns after eight years of a deadly war in which tens of thousands of Americans died. So that's the primary concern, and then how to govern these colonies. So issues of health don't get mentioned so much in the debate at that time, at the time of the Constitution.
They have that ambiguous phrase that the new government should protect for the general welfare citizens. But even at that time, there were concerns about, you know, what that actually meant. The first real test comes when yellow fever breaks out across the East Coast of the United States in 1793, just four years after the Constitution was written. And then, in Congress, you see some debate over what the federal government should do.
CONAN: That was a debate over the National Quarantine Bill. What was the issue there?
Mr. WEHRMAN: Well, the issue was that each town had - Philadelphia is where the yellow fever broke out most severely. And they had to - local towns had different quarantine laws. So, for instance, during that epidemic, Boston might not want to receive trade from Philadelphia, thinking that the trade might be infected. They had no idea where this yellow fever was coming from. They didn't have a concept of the germ theory of disease.
CONAN: And it would be a hundred years before Walter Reed figured it out.
Mr. WEHRMAN: Yeah, of course. So, different towns were putting different measures of quarantine, and all these regulations really interrupted trade. So the Congress comes in, saying, because we have the responsibility to regulate interstate commerce, we need to do something about those disease, doesn't stop at the state border. It becomes a federal responsibility. So, Samuel Smith, a representative from Maryland, introduces the National Quarantine Bill and he hopes to give the president - George Washington at first and then John Adams as the debate continues - the power to regulate a national quarantine, sort of act, which was about the only thing that people thought would help against yellow fever, even that was controversial.
ARTHUR: All right. Well, thank you very much.
CONAN: Arthur, thank you. It's interesting that in 1799, you write, Congress also authorized the construction and funding of marine hospitals for sick or disabled merchant sailors in most American port cities, a decision that had some consequences.
Mr. WEHRMAN: Yeah. So, the National Quarantine Bill really puts states in control of quarantines. And it says that the president has the responsibility to aid the states in their quarantine regulations. But then, in 1799, they passed this Marine Hospital Act which is a federally regulated system of marine hospitals. They tax sailors to build these hospitals, and they're built in a couple dozen port cities. And some of them are built by the federal government, run the government. Some are just funded and then run by individual towns. It was a hybrid sort of system. But that is where the Public Health Service and the Office of the Surgeon General later in the 19th century. It grows out of that marine hospital system.
CONAN: Let's get another caller on the line. This is George(ph) calling us from San Antonio.
GEORGE (Caller): Yes. I've been doing research on the Spanish archives here in San Antonio. And the first hospital in Texas was a military hospital at the Alamo in 1806, and they gave small pox inoculations to the town's children and to the garrison's children. And it was - eventually, allowed the town's people to actually use the hospital for a peso a day which was about a day's wage.
CONAN: So, it sounds like that was a pretty good health care system.
GEORGE: Well, they gave the patients cigarettes and mutton suit with a…
(Soundbite of laughter)
CONAN: May have been - may not have been…
GEORGE: …every day.
CONAN: It may not have been the wisest choices.
GEORGE: Well, you know, the - but it is interesting that they did allow the public to - apparently, at various times, to use it. But they had a big complaint early about one of the early doctors and he had to leave town under a cloud. But it's sort of the early case of, sort of, socialize medicine was strangely enough upstairs and one of the buildings in the Alamo.
CONAN: All right. George, thanks very much for that. Appreciate it.
CONAN: Historical anecdotes from all over. Andrew Wehrman, thank you so much for your time today.
Mr. WEHRMAN: Well, thank you very much. I enjoyed being here.
CONAN: Andrew Wehrman, his story for the Boston Globe, "A Pox on You" is available at our Web site at npr.org. It was adapted from an essay he wrote in the September issue of the New England Quarterly, and he joined us today from the studios of Chicago Public Radio. He's a doctoral student at Northwestern University in Chicago.
You're listening to TALK OF THE NATION coming to you from NPR News.