Pox: An American History. By Michael Willrich. Penguin. $27.95.
“What Will Happen to Me?” By Howard Zehr and Lorraine Stutzman Amstutz. Portraits by Howard Zehr. Good Books. $14.95.
Anyone who thinks “Obamacare” is intrusive – and people of good will can disagree about this, and even about whether the “Obamacare” label is a fair one – could use a history lesson in really intrusive U.S. government healthcare. That is what Michael Willrich presents in Pox, and presents both so entertainingly (if that’s the right word) and so thoughtfully that this book ought to be required reading for all sides in the ongoing argument about the proper federal role in individual healthcare decisions. It is fair to say that all sides in the current debate would likely agree that the eradication of smallpox was a major public-health triumph, and that is what Willrich, an associate professor of history at Brandeis University, writes about here. But it is equally fair to say that 21st-century opinions would splinter even more than they already have if today’s federal government tried to do anything remotely approaching what the government did in the early 20th century. If the end justifies the means, the government did enormous public good – but if it does not, the harm was well-nigh irreparable, and resounds to the present day.
The federal government was almost unimaginably smaller at the beginning of the 20th century – the huge apparatus with which we are familiar today dates only to Franklin D. Roosevelt’s time – and the notion of citizens’ rights was considerably less well defined: women could not yet vote, the “inferiority” of blacks was generally accepted, and the large immigrant population was looked down upon and frequently victimized. The U.S. was in some ways a more “tribal” nation then: Italians, Irish, Jews and other groups had their accepted “places” in society and rarely moved out of them (Irish policemen, for example). Furthermore, the Civil War was still very much a living memory – a fact of some importance in Willrich’s narrative, since a primary figure here is a passionate medical advocate of vaccination named Charles Poindexter Wertenbaker, who was born in 1860; and as was the case with “most Americans born before the Civil War, [his] first loyalties were to family, community, state, and God.” Wertenbaker became an expert in the diagnosis of smallpox, and became an advocate of the new smallpox vaccine in the 1890s, when he observed first-hand the effectiveness of the primitive vaccination system then in place – and the horrible effects of the disease on the unvaccinated. Furthermore, at this time in U.S. history, if “American jurists were certain about anything it was this: the states could take any action necessary to protect their citizens from the ‘present danger’ of a deadly infectious disease.” Thus, as smallpox spread and the efficacy of the vaccine seemed more and more apparent, Wertenbaker, as the federal government’s main point man implementing a universal-vaccination policy, became stronger and stronger in his advocacy of the vaccine, at one point insisting that the only people who should be permitted to neglect the “duty” of being vaccinated were those who had had smallpox already and “those who are dead.” People were vaccinated under duress, under threat, and sometimes only through threats and heavy-handed enforcement by police, Texas Rangers and the U.S. Cavalry. Predictably in a nation with a deep-seated suspicion, even at this time, of central control, Wertenbaker and the universal-vaccination policy became controversial, and resistance took shape in the form of an anti-vaccination movement. The unreliability of the smallpox vaccine and its occasionally severe side effects fed public worry and opposition, and the entire issue became so contentious that, eventually, a highly important Supreme Court case was needed to decide what the government could and could not do in the name of public health. This was Jacobson vs. Massachusetts, a 1905 decision that may well be cited when the “Obamacare” issue eventually reaches today’s Supreme Court. In his majority Jacobson opinion, Justice John Marshall Harlan disagreed with Henning Jacobson’s assertion that it was “the inherent right of every freeman to care for his own body and health in such way as to him seems best.” Liberty in the United States is conditional liberty, Harlan wrote, because “there are manifold restraints to which every person is necessarily subject for the common good.” Willrich’s account of this case is fascinating, although he tends to get into too much detail in relating the medical and societal issues throughout the book to the notion of the rise of the Progressive movement, even stating that “Harlan tellingly expressed [himself] in the political key words of progressivism.” This emphasis is not wrong, but it makes Pox unnecessarily diffuse and may make the sprawling book less appealing to some readers. Nevertheless, the decision that compulsory smallpox vaccination – even when mandated and carried out as heavy-handedly as it was in the U.S. at this time – was legitimate and served a constitutionally supportable public purpose, had immediate and far-reaching implications. For example, states seeking to justify their incursions into individual decision-making seized on it as justification whenever they could cite (or create) a public-health benefit for their laws. The decision was subsequently muddied and modified, but it is quite likely to be revisited sooner rather than later as our current arguments about individual vs. societal health-related rights wend their way through the legal system. Smallpox is gone. The societal issues raised by the method of its eradication are not – and will not likely be settled anytime soon.
Nor are these by any means the only issues in which the legal system has to pick winners and losers. Sometimes the losers are the innocent – for example, the three million children who go to bed each night with a parent who is in prison or jail. “What Will Happen to Me?” (the quotation marks are part of the title) is a book of, as the authors put it, “restorative justice,” intended to balance the needs of “those who have offended, those who have been offended against, and their families.” Howard Zehr and Lorraine Stutzman Amstutz devote most of the book to the faces and voices of children with incarcerated parents. Jalon: “When my mom was gone, I’d cry myself to sleep.” Jasmine: “It just made my head hurt, my brain hurt, my stomach hurt. It just got control of me.” Deedee: “I’ll probably have kids by the time [mama] gets out. Taking them to the jailhouse – that’s not where I want them to remember her from.” Taylor: “I want other kids to know that even though your parents are locked up, they’re not bad people. They just did something that they shouldn’t have done. And it really affects us, the kids. It really does.” Indeed it does, and it is impossible not to feel deeply for these children (some of them young adults) who have themselves done no wrong but are paying a high price for their parents’ misdeeds. Nevertheless, this book is too one-sided and simplistic to garner more than a (+++) rating, because it largely neglects the other innocents – the people victimized by the crimes of these kids’ parents. These children say nothing about that subject (or the authors have edited out their comments). Amnessia, for instance, says, “My grandma came to school and got us. She didn’t explain nothing. My dad went into prison not too much after that. That’s my stepdad. And then my auntie went in. They all went in on the same charges.” Which were what, exactly? We never find out. Would knowing what the parents did make the plight of these children any less? No – but it would help explain just how serious the parents’ crimes were, since (whatever they may have done) the parents damaged their kids and their victims. Indeed, their kids are themselves victims; but they are not the only ones, although that is what this book in effect implies. Zehr and Amstutz create a short but moving “for caregivers” section, but perhaps their greatest contribution is a five-page chapter called “Ten Questions Often Asked by Children Whose Parents Are in Prison.” These questions – from “Where is my mom or dad?” to “Is this my fault?” – are entirely reasonable, if heartbreaking, and the authors’ suggestions on answers are well considered. For example, regarding “Why is she or he in jail or prison?” they say, in part, “When a parent has done wrong, it is important that this wrongdoing is acknowledged. Children need to know that there are consequences when people do things that are against the law or harmful to others.” Other highly useful sections of “What Will Happen to Me?” deal with handling emotions (grief, loss, shame, etc.), staying in touch with incarcerated parents, and what to do when a parent is released and comes home. The book’s final section, “A Matter of Justice,” is a plea for a restorative rather than punitive system that will take into account what crime does to perpetrators, their families, and, yes, their victims. But it gives short shrift to victims’ rights – for example, it is fine to suggest a system in which we “acknowledge and repair the harm that has been done,” but how does a criminal repair long-lasting or permanent physical injury done to a victim, or the mental injury (such as a sense of never being safe again) created by a “simple” break-in or mugging? There is something noble in the attempt by Zehr and Amstutz to make it clear that children of criminals are additional victims of crime – but true restorative justice has to give the primary victims a great deal more than the authors here suggest.