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The smallpox epidemic of 1924-'25
By Mary Losure
Minnesota Public Radio
November 26, 2001

Minnesota's Experience with Smallpox, a report issued in 1925 by the Minnesota Department of Health, describes the state's worst smallpox epidemic, which raged from 1924-1925. Before the outbreak ended in August, 1925, 4,041 people were stricken with smallpox and 504 died. Here are some excerpts from the report.

Smallpox patient Harvey Watkins is being tended to by an unidentified caregiver in November, 1900.
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(Photo courtesy of Minnesota Historical Society)

•On January 26, 1924, a Canadian, 54 years old, never vaccinated, died of hemorrhagic smallpox. Ten days after leaving Canada, he had developed severe backache and general pains, but since these symptoms followed an accident, they were thought to indicate internal injuries and he was admitted to a Duluth hospital, January 20 as a surgical case. On January 25, the diagnosis of hemorrhagic smallpox was made. Meanwhile considerable exposure had occurred.

One hundred and sixty cases of the malignant type of smallpox with 37 deaths [in St. Louis, Carleton, Aitkin, and Lake of the Woods Counties] were traced directly or indirectly to this first fatal case. In Duluth there were 54 cases with 15 fatalities.

The local health officers not only enforced strict quarantine wherever the malignant type of smallpox appeared, and traced and vaccinated everyone known to have been exposed - keeping them under supervision until all doubt about the outcome was past, but also through effective publicity induced the people to be vaccinated by private physicians or at the free public vaccination stations. This outbreak was confined to northeastern Minnesota and terminated in July.

•On February 1, 1924, a plasterer who had worked in Minneapolis since December 13, 1923, and had not been out of the city, returned to his home in Fairmont, Martin County. On February 9 he was taken sick. Before the diagnosis was made a number of persons had been exposed. He died February 23. The circumstances which gave rise to this case have never been ascertained. The infection spread to Martin County where it sickened 24 and killed four.

•The first case of malignant smallpox recognized during life in Minneapolis was a woman who came to Minneapolis June 11, and entered the obstetric ward of the University Hospital in labor June 24. On July 2, she developed symptoms of smallpox and was admitted to the Minneapolis General Hospital where she died July 15, 1924. This woman and others who developed malignant smallpox at that time had visited the outpatient department of the Minneapolis General Hospital since coming to Minneapolis. That earlier cases were not recognized as smallpox had occurred was evident. Careful review of autopsy findings and history shows beyond doubt that on June 23, 1924, an orderly in the Minneapolis General Hospital who worked in the contagious disease department died of hemorrhagic smallpox after an illness of three days.

•In St. Paul the first recognized case of malignant smallpox died August 31, 1924. The patient was an unvaccinated two-year-old child in a family living over a grocery store kept by the family. The mother and three other children had smallpox with moderately severe symptoms. October 29, 1924, the next case died in St. Paul.

•November 15, 1924, at a special meeting, the State Board of Health adopted a regulation and a resolution declaring smallpox epidemic in Minnesota, and authorizing local boards of health to arrange for free voluntary vaccination of all inhabitants - not only in those health districts where cases of smallpox already existed, but also in those districts were no smallpox cases were present.

A special investigation of smallpox in the Twin Cities found lax containment practices by the Minneapolis Department of Health had contributed substantially to the spread of the outbreak from the Twin Cities to other areas of Minnesota and to other states. Six outbreaks, 17 cases and four deaths were traced to St. Paul. In Minneapolis, 43 outbreaks, 114 cases and 29 deaths were traced.

The report compares containment practices in the two cities as follows.

•In St. Paul, practically no privileges had been extended to exposed persons, whether vaccinated or revaccinated.

•In Minneapolis the Health Commissioner had granted privileges to wage earners and others exposed, even allowing nurses on cases to go home to sleep.

•[In St. Paul] the information obtained shows:

That the Bureau of Health assisted in making diagnoses, put forth much effort in searching for sources of infection and in the follow-up of contacts. That private homes were strictly quarantined and that privileges of entering and leaving quarantined premises, commonly granted to persons protected by vaccination when dealing with mild smallpox, were withheld. That places of business in which smallpox developed in workers were promptly investigated and advised as to vaccination, and that a later checkup on successful vaccinations was made. That in hospitals prompt investigations were made.

• [In Minneapolis] the information obtained shows:

That up to January 16, 1925, when our investigation was begun, the Minneapolis Health Department apparently had put forth but little effort in searching for sources of infection and in following up contacts to cases. That families living under the same roof and using common halls, and in some instances other common appointments, were not warned or advised following the occurrence of first cases, and that in some instances of this kind secondary cases occurred which apparently might have been averted. That places of businesses generally, where cases occurred in workers who continued their work for one or more days after onset, were not advised further than to be notified that the individual taken sick should not return to work without a health officers certificate, and in many places no notification or advice of any kind was received.

That in five hospitals investigated in which cases had occurred prior to January 16, no investigation had been made by the health department. That in certain lodging houses to which a large number of the city poor were officially assigned, no attempt had been made to protect them through vaccination at the time of assignment, and even after first cases of smallpox developed in on of these lodging houses and request for assistance in carrying out vaccination had been made, no assistance was given. The only advice that was given was that this lodging house, which is largely a charitable institution, look after vaccinating its patrons and beneficiaries, and large number of whom, as stated above, were officially assigned by the city of Minneapolis.

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