Behind the Photograph: Smallpox at Hoffman Island, New York

I was recently doing some research on historical photographs on the website for the US Library of Congress when I came upon this image:

Immigrants from a smallpox ship, held in custody for observation, behind wire fence, Hoffman Island, N.Y.

In the notes section of the photograph’s page, I saw that the image was taken by Elizabeth Alice Austen. Ms. Austen had quite a life, born in 1866 and dying 86 years later after being one of the first women photographers in the United States who worked outside of a studio. The Alice Austen House Museum is now located at her former home on Staten Island, and it is “a nationally designated site of LGBTQ history.”

East of Staten Island on the Hudson River is Hoffman Island, a man-made island created to keep immigrants in quarantine when they arrived to the United States at the Port of New York. According to The New York Times:

In New York, the ugly apogee of disease-related Nimby-ism came in September of 1858, when a well-organized mob of Staten Island residents, inflamed by xenophobia and fear of deadly yellow fever, stormed a 30-acre quarantine hospital in the area now known as St. George and set the place ablaze.
In the aftermath of this violence, which stemmed from the location of an infectious-disease facility within a population center, The New York Times noted with grim irony that “the great problem of the age seems to be, to establish a Quarantine without having it located anywhere.”

Hoffman Island, at 11 acres the larger of the two, was built between Coney Island and Staten Island’s South Beach, south of the slender waterway known as the Narrows; it was equipped with three brick buildings and later expanded. Four-acre Dix Island, a wind-whipped speck of land, was created about three-quarters of a mile farther south and outfitted with a row of long white hospital wards. It was later renamed Swinburne Island.

“Islands Created for Quarantines” by John Freeman Gill, May 22, 2020

What was going on in May 1901 (the date the photograph was taken) regarding smallpox? Between 1901 and 1905, the United States and the United Kingdom (and a number of other countries) experienced a smallpox epidemic. Boston was hit hard. Cleveland almost collapsed. As a result of the misunderstanding and xenophobia that accompanies epidemics,* public health authorities opted to quarantine immigrants at Hoffman Island (and other ports of entry). It was only through vaccination that the epidemic was brought under control. This was because the lack of understanding of the virus — where it is infectious before symptoms fully appear — led to people walking around in public if they didn’t meet the criteria of being immigrants.

That vaccination effort, especially in Massachusetts, led to the compulsory laws whereby an adult refusing to be vaccinated against smallpox faced a $5 fine (about $150 in today’s dollars). Pastor Henning Jacobson refused to receive the vaccination claiming that he had a history of adverse reactions to vaccination. After being fined, Pastor Jacobson sued, claiming that forced or compulsory vaccination by the State was a violation of his individual liberty. The case went all the way to the Supreme Court of the United States. In 1905, the Court ruled in Jacobson v Massachusetts that the State had the authority, via its police powers granted under the United States Constitution, to compel a person to follow a public health order under certain circumstances. In the case of Pastor Jacobson, Cambridge, Massachusetts, was in the grip of the smallpox epidemic, and vaccination was the only way to bring it under control.

By 1979, after a worldwide effort to identify every case and vaccinate every person around the world, smallpox was eradicated. The only known stockpiles of the virus are kept at the Centers for Disease Control and Prevention (CDC) laboratories and at the Russian State Centre for Research on Virology in Koltsovo, Russia. The smallpox vaccine, however, continues to be given to laboratory workers (working on smallpox or other pox viruses) and to some members of the military.

That picture of the quarantined men at Hoffman Island is only one of many great photographs taken by Elizabeth Alice Austen. Check out her the rest of her collection here:

*Places around the world, and the United States in particular, have seen a rise in anti-Asian sentiment — including violence — during the COVID-19 pandemic. This has been fueled, in part, by conspiracy theories tying the emergence of the novel coronavirus to the Chinese Government. Unfortunately, there are too many people who cannot differentiate between the different racial, ethnic and national origins of Asian-Americans.

Author: René F. Najera, DrPH

I am the editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia. All opinions expressed on these blog posts are not necessarily those of the College or any of my employers. Check out my professional profile on LinkedIn: Feel free to follow me on Twitter: @EpiRen