Jacobson v. Massachusetts (1905)
Background Information
Understanding the facts and constitutional questions
Connecting to Our Guiding Question
When, if ever, should the government be allowed to limit a person's constitutional rights in order to protect the community?
This case asks whether a state may fine an adult who refuses a smallpox vaccination during an outbreak. As you read, weigh one person’s liberty against the safety of the community. Jacobson wanted to decide what was done to his own body. The city wanted to stop a deadly disease from spreading.
Key People in This Case
A pastor at a Swedish Lutheran church in Cambridge, Massachusetts. He was born in Sweden in 1856 and came to the United States as a boy. In 1902 he refused to be vaccinated against smallpox and was charged under a state law.
The state whose law let a city’s board of health require vaccination during a health emergency and fine adults $5 for refusing.
The city board that ordered everyone not vaccinated since March 1, 1897, to be vaccinated. Its chairman offered to vaccinate Jacobson for free.
What Happened?
In 1901, smallpox broke out in Boston and the cities around it. Smallpox is a contagious disease that causes a high fever and a blistering rash. It killed many of the people who caught it. The outbreak lasted until 1903, and during that time 270 people died of smallpox in Boston alone.
Massachusetts already had a law about vaccination. Vaccination protects a person from a disease by training the body to fight it. The law let a city’s board of health require everyone to be vaccinated if the board decided it was necessary for public health or safety. The city had to provide the vaccinations for free. An adult over 21 who refused had to pay a $5 fine. Children whose doctor certified that they were “unfit subjects for vaccination” were excused. The law had no matching exception for adults.
On February 27, 1902, the Cambridge Board of Health used that law. Its order said smallpox had been “prevalent to some extent” in the city and “still continues to increase.” It required everyone who had not been successfully vaccinated since March 1, 1897, to be vaccinated or vaccinated again.
Henning Jacobson was the pastor of a Swedish Lutheran church in Cambridge. The chairman of the board of health told him that he would be prosecuted if he refused. The chairman also offered to vaccinate Jacobson for free. Jacobson declined.
Jacobson was charged in a local court in 1902 and pleaded not guilty. He asked to prove to the jury that vaccination “quite often” caused serious harm. He also said that a vaccination he received as a child had caused him “great and extreme suffering.” He said he had seen the same thing happen to his son. The judge ruled that none of this evidence could be heard. The jury found him guilty. Massachusetts’s highest court upheld the trial in 1903, and Jacobson was sentenced to pay the $5 fine. He took his case to the Supreme Court of the United States. The Court heard arguments on December 6, 1904.
The Big Question
May a state make adults choose between vaccination and a fine during a disease outbreak, or does that take away the liberty the Fourteenth Amendment protects?
What You Need to Know
The Fourteenth Amendment, ratified in 1868, says:
“…nor shall any State deprive any person of life, liberty, or property, without due process of law…”
Jacobson argued that the vaccination law took away his liberty and that it treated adults unfairly, because children could be excused with a doctor’s note and adults could not. Massachusetts argued that protecting the public from deadly disease is part of its police power. Police power is the power every state has to make laws for the health and safety of its people.
Important Facts
- Smallpox was spreading in Cambridge when the board made its order.
- Vaccination was free, and the penalty for refusing was a $5 fine.
- Children with a doctor’s certificate could be excused, but adults had no medical exception in the law.
- The trial judge did not let Jacobson show the jury his evidence about harm from vaccination.
- In 1901, nine children in Camden, New Jersey, died of tetanus after receiving contaminated smallpox vaccine. In 1902, Congress passed its first law regulating how vaccines were made.
Vocabulary
Argument Sorting Activity
Work with your group to sort these arguments
Instructions: For each argument, choose which side you would use it for, or “Both.” There is no score. The same fact can help opposite sides. Then rank and steelman in Weigh below.
The Two Sides
Henning Jacobson
The Fourteenth Amendment protects each person’s liberty. That includes the right to decide what is done to his own body. A state should not punish an adult who refuses a medical procedure he believes could harm him. This is especially true when the court would not let him prove that harm.
Commonwealth of Massachusetts
Protecting the public from deadly disease is one of a state’s oldest powers. During an outbreak, one person’s refusal puts neighbors at risk. Elected lawmakers and health boards should decide what the whole community needs, not a single jury.
| Argument | Answer |
|---|---|
| A free country lets each adult decide what is done to his own body. Evidence: In Allgeyer v. Louisiana (1897), the Supreme Court said the “liberty” in the Fourteenth Amendment means more than “the right of the citizen to be free from the mere physical restraint of his person, as by incarceration.” | |
| Smallpox was spreading in Cambridge when the vaccination order was made. Evidence: The Cambridge Board of Health’s order of February 27, 1902, said smallpox had been “prevalent to some extent” in the city and “still continues to increase.” | |
| The law excused children with a doctor’s note but gave adults no medical exception. Evidence: The statute excused “children who present a certificate, signed by a registered physician, that they are unfit subjects for vaccination.” It said nothing about adults with the same problem. | |
| The state offered vaccination for free, so cost kept no one from obeying. Evidence: The law said the board of health “shall provide them with the means of free vaccination.” | |
| Vaccines in that era were not always safe or pure. Evidence: In 1901, nine children in Camden, New Jersey, died of tetanus after receiving contaminated smallpox vaccine (U.S. Food and Drug Administration history). | |
| Health laws have long been part of what states control. Evidence: In Gibbons v. Ogden (1824), Chief Justice John Marshall listed “quarantine laws, health laws of every description” among the laws that belong to the states. | |
| Jacobson should have been allowed to show the jury his evidence about harm. Evidence: The trial judge ruled that every fact Jacobson offered to prove was “immaterial” and excluded all of it, according to the case record. | |
| If anyone could refuse, the order could not stop the outbreak. Evidence: The board’s order said it was “necessary for the speedy extermination of the disease that all persons not protected by vaccination should be vaccinated.” | |
| A vaccination he received as a child caused him serious harm. Evidence: Jacobson offered to prove that a childhood vaccination caused him “great and extreme suffering for a long period,” and that he had seen the same result in his son. | |
| Courts in other states had already upheld vaccination rules. Evidence: In Viemeister v. White (1904), New York’s highest court upheld a rule that kept unvaccinated children out of public school. | |
| Elected lawmakers and health boards, not juries, should weigh medical evidence for a whole city. Evidence: The law gave the power to the board of health “if, in its opinion, it is necessary for the public health or safety.” | |
| Punishing a person for refusing a medical procedure goes too far, even if the penalty is small. Evidence: Jacobson was found guilty of a crime, sentenced to pay $5, and ordered held until the fine was paid, according to the case record. |
Key Terms for Arguments
Important concepts to understand when debating this case
The power every state has to make laws for the health, safety and welfare of its people. Massachusetts says a vaccination order during an outbreak is a clear use of this power.
The Fourteenth Amendment says no state may take away a person’s liberty without due process of law. Jacobson says that liberty includes refusing a medical procedure for his own body.
Evidence Vault
Real sources to build your debate arguments
Complete the Argument Sort to Unlock
Finish the Argument Sort above, then open the Evidence Vault for real case sources.
Analyze the Sources
Read each excerpt carefully. Decide which side of the case it supports, or if it could be used by both sides.
Liberty in the Fourteenth Amendment
Liberty in the Fourteenth Amendment
Contaminated Vaccine in 1901
Contaminated Vaccine in 1901
The Cambridge Order
The Cambridge Order
A Deadly Outbreak
A Deadly Outbreak
The Massachusetts Law
The Massachusetts Law
Health Laws Belong to the States
Health Laws Belong to the States
Connecting to Today
How these constitutional questions still matter
Public health laws are still debated across the United States. Here are two dated examples:
School Vaccine Rules
On July 28, 2019, a new Washington law took effect that ended personal and philosophical exemptions from the measles, mumps and rubella (MMR) vaccine for students in public and private schools and child care. Medical and religious exemptions stayed in place.
Think about: Should a school vaccine rule allow exemptions for personal beliefs, religion or medical reasons? Which ones, and why?
Source: Washington State Legislature, Final Bill Report, EHB 1638 (2019)
Workplace Vaccine Rules
On January 13, 2022, the Supreme Court blocked a federal rule that would have required workers at large companies to be vaccinated against COVID-19 or tested weekly. The same day, it allowed a different rule requiring vaccination for most workers at health care facilities paid by Medicare and Medicaid. Both decisions turned on what federal agencies are allowed to do under the laws Congress passed.
Think about: Should the rules be different for a hospital worker and an office worker? Why?
Source: NPR, January 13, 2022
Who Decides?
When a disease spreads, who should decide what each person must do: the person, doctors, elected lawmakers, or courts?
Think about: Does your answer change if the disease is more deadly?
Discussion Questions
- Should the rules for adults and children be different when it comes to health requirements?
- Is a fine different from forcing someone to do something? How?
- How should a court handle a person’s own medical history when a law applies to everyone?
Additional Resources
For after your debate: these explain how the Court ruled