7 Public Health 7 Public Health

7.1 Compagnie Francaise de Navigation a Vapeur, Plff. in Err., v. State Board of Health, Louisiana 7.1 Compagnie Francaise de Navigation a Vapeur, Plff. in Err., v. State Board of Health, Louisiana

1. You may do better by reading the syllabus first, the dissent second, and the majority opinion of Justice White last. 

2. As I write this, the Omicron variant of COVID-19 is sweeping through almost all of the country. Could Texas close its borders (temporarily) to traffic from other states on grounds that its hospitals are overrun and that adding more people to the population increases the number of persons who could be infected and thereby endanger public health?

3. Notice that, at the time, quarantine regulations were still largely the province of the states. This is still true today, although the Public Health Service Act does give the federal government some power in this area.

4. Although the court makes no mention of it, there was a history of prejudice in New Orleans against Italians. See this article from The History Channel.

22 S.Ct. 811

Supreme Court of the United States.

COMPAGNIE FRANCAISE DE NAVIGATION A VAPEUR, Plff. in Err.,

v.

STATE BOARD OF HEALTH, LOUISIANA, et al.

No. 4.

|

Argued October 29, 30, 1900.

|

Decided June 2, 1902.

Synopsis

IN ERROR to the Supreme Court of the State of Louisiana to review a judgment affirming a judgment of the trial court which dismissed a suit to recover damages from the state board of health alleged to have been suffered from the enforcement of a quarantine resolution. Affirmed.

 

See same case below, 51 La. Ann. 645, 25 So. 591.

 

Attorneys and Law Firms

**813 *384 Messrs.W. B. Spencer and W. W. Howe for plaintiff in error.

Mr.F. C. Zacharie for defendants in error.

Opinion

 

**812 Statement by Mr. Justice White:

 

*380 This action was commenced in the state court against the board of health of the state of Louisiana and three persons who were members of said board, and whom it was sought to hold individually responsible for damages alleged to have been suffered from the enforcement of a resolution adopted by the board upon the theory that the resolution referred to was ultra vires, and hence the members of the board who voted for it *381 were personally liable for any damages occasioned by the enforcement of the resolution. The board was thus described in the petition:

‘That the defendant the state board of health was a body created by act No. 192 of the general assembly of the state of Louisiana of the year 1898, with power to sue and be sued, domiciled in this city (the city of New Orleans), and composed of seven members, whose duty it was, by the provisions of said act, to protect and preserve the public health by preparing and promulgating a sanitary code for the state of Louisiana, by providing for the general sanitation of the state, and with authority to regulate infectious and contagious diseases and to prescribe a maritime and land quarantine against places infected with such diseases.’

It was asserted that the plaintiff, a corporation created by and existing under the laws of the Republic of France and a citizen of said Republic, on or about September 2, 1898, caused its steamship Britannia to be cleared from the ports of Marseilles, France, and Palermo, Italy, for New Orleans with a cargo of merchandise and with about 408 passengers, some of whom were citizens of the United States returning home, and others who were seeking homes in the United States, and who intended to settle in the state of Louisiana or adjoining states, and that all the passengers referred to at the time of their sailing were free from infectious or contagious diseases. It was further averred that on September 29, 1898, the vessel arrived at the quarantine station some distance below the city of New Orleans, was there regularly inspected, and was found, both as to the passengers and cargo, to be free from any infectious or contagious disease, and accordingly was given a clean bill of health, whereby the ship became entitled to proceed to New Orleans and land her passengers and discharge her cargo. This, however, it was asserted she was not permitted to do, because, on the date last mentioned, at a meeting held by the board of health, the following resolution was adopted:

Resolved, That hereafter in the case of any town, city, or parish of Louisiana being declared in quarantine, no body or bodies of people, immigrants, soldiers, or others shall be allowed *382 to enter said town, city, or parish so long as said quarantine shall exist, and that the president of the board shall enforce this resolution.’

It was charged that in order to enforce this resolution the president of the board of health, who was one of the individual defendants, instructed the quarantine officer to detain the Britannia at the quarantine station, and the president of the board addressed to the agent of the steamship the following communication explanatory of the detention of the vessel:

‘Referring to the detention of the SS. Britannia at the Mississippi river quarantine station, with 408 Italian immigrants on board, I have to inform you that under the provisions of the new state board of health law, § 8, of which I inclose a marked copy, this board has adopted a resolution forbidding the landing of any body of people in any town, city, or parish in quarantine. Under this resolution the immigrants now on board the Britannia cannot be landed in any of the following parishes of Louisiana, namely: Orleans, St. Bernard, Jefferson (right bank), St. Tammany, Plaquemines, St. Charles, or St. John. You will therefore govern yourselves accordingly.’

The president of the board of health, it was alleged, moreover notified that agent of the ship that if an attempt was made to land the passengers at any place contiguous to New Orleans, such place not being in quarantine, a quarantine against such place would be declared, and thus the landing be prevented.

It was averred that while the resolution of the board of health purported on its face to be general in its operation, in truth it was passed with the sole object of preventing the landing of the passengers from the Britannia, and this was demonstrated because no attempt was made by the board of health to enforce the provisions of the resolution against immigrants from Italy coming into the United States via the port of New York and thence reaching New Orleans by rail, and that after the promulgation of said resolution ‘more than 200 such persons varying in groups of 30 to 100 in number, have from time to time been permitted to enter said city.’ It was averred that the action of the board was not authorized by the state *383 law, and if it was, such law was void because repugnant to the provision of the Constitution of the United States conferring upon Congress power ‘to regulate commerce with foreign nations, and among the several states and with the Indian tribes.’ Averring that damage had been already entailed to the extent of $2,500, for which not only the board, but its members who voted for the resolution, were liable, and reserving the right to claim such future damage as might be entailed by the further enforcement of the resolution, the petition asked for an injunction restraining the enforcement of the resolution in question, and prayed judgment against the board and the members named for $2,500 in solido.

The court declined to allow a preliminary restraining order, and upon a hearing on a rule to show cause, the injunction was refused. The order of the board of health, which was complained of, continued, therefore, to be enforced against the ship. Subsequently the plaintiff filed a supplemental and amended petition. It was reiterated that the immigrant passengers on board the Britannia were free from disease when they shipped and at the time of their arrival, and, in addition, it was alleged that the steamer with the immigrants on board had sailed from her port of departure ‘prior to the declaration by said board of health of the existence of any infectious disease in the city of New Orleans.’ It was alleged that, in consequence of the insistence of the board of health and its members, in enforcing the illegal order refusing to allow the landing of the immigrant passengers, the steamer had been obliged to proceed to Pensacola, Florida, where they were landed, and then the steamer returned to New Orleans for the purpose of discharging cargo. The damage resulting was averred to be $8,500, besides the $2,500 previously claimed, and a judgment for this amount, in addition to the previous sum, was also asked in solido against the board and the members thereof, who were individually made defendants. It was, moreover, averred that the action of the board was ‘in violation of the laws of the United States, and the rules and regulations made in pursuance thereof, relating to quarantine and immigration from foreign countries into ports of the United States, and especially acts of Congress approved February 15, 1893, and acts of Congress of March the 3d, 1893, August the 3d, 1882, and June the 26th, 1884, and the rules and regulations made in pursuance thereof, and of the treaties now existing between the United States, on the one part, and the Kingdom of Italy and the Republic of France on the other part.’

The defendants filed a peremptory exception of no cause of action, which was sustained by the trial court, and the suit was therefore dismissed. On appeal to the supreme court of the state of Louisiana the judgment of the trial court was affirmed. 51 La. Ann. 645, 25 So. 591.

 

Mr. Justice White, after making the foregoing statement, delivered the opinion of the court:

 

The law of Louisiana, under which the board of health exerted the authority which is complained of, is found in § 8 of act No. 192, enacted in 1898. The portion of the section which is essential is as follows, the provision which is more directly pertinent to the case in hand being italicized:

‘In case that any parish, town, or city, or any portion thereof, shall become infected with any contagious or infectious disease, to such an extent as to threaten the spread of such disease to the other portions of the state, the state board of health shall issue its proclamation declaring the facts and ordering it in quarantine, and shall order the local boards of health in other parishes, towns, and cities to quarantine against said locality, and shall establish and promulgate the rules and regulations, terms and conditions on which intercourse with said infected locality shall be permitted, and shall issue to the other local sanitary authorities instructions as to the measures adopted in quarantining against persons, goods, or other property coming from said infected localities, and these rules and regulations, *385 terms and conditions shall be observed and obeyed by all other health authorities, provided that should any other of the noninfected portion of the state desire to add to the regulations **814 and rules, terms and conditions already imposed by the state board, they do so on the approval of the state board of health. The state board of health may, in its discretion, prohibit the introduction into any infected portion of the state, persons acclimated, unacclimated, or said to be immune, when in its judgment the introduction of such persons would add to or increase the prevalence of the disease. The state board of health shall render the local boards of health all the assistance in their power and which the condition of their finances will permit.’

The supreme court of the state of Louisiana, interpreting this statute, held that it empowered the board to exclude healthy persons from a locality infested with a contagious or infectious disease, and that this power was intended to apply as well to persons seeking to enter the infected place, whether they came from without or from within the state. The court said:

‘The law does not limit the board to prohibiting the introduction of persons from one portion of the state to another and an infected portion of the state, but evidently looked as well to the prohibition of the introduction of persons from points outside of the state into any infected portion of the state. As the object in view would be ‘to accomplish the subsidence and suppression of the infectious and contagious diseases, and to prevent the spread of the same,’ it would be difficult to see why parties from outside of the state should be permitted to enter into infected places, while those from the different parishes should be prevented from holding intercourse with each other.

‘The object in view was to keep down, as far as possible, the number of persons to be brought within danger of contagion or infection, and by means of this reduction to accomplish the subsidence and suppression of the disease and the spread of the same.

‘The particular places from which the parties, who were to be prohibited from entering the infected district or districts, came could have no possible influence upon the attainment of the result sought to be attained.

*386 ‘It would make no possible difference whether this ‘added fuel’ sought to be excluded should come from Louisiana, New York, or Europe.’

Referring to past conditions and the public dangers which had arisen from them, the evil which the statute of 1898 was intended to remedy was pointed out as follows:

‘During the fall of 1897, and during the existence of an epidemic, a vessel arrived in the Mississippi river with immigrants aboard under conditions similar to those under which the ‘Britannia’ reached the same stream in 1898.

‘The excited public discussions at the time as to the right of the state board, under the then existing law, to prevent the landing of the immigrants and as to its duty in the premises, were so extended as to authorize us to take judicial notice of the fact, and in our opinion the clause in the present act which covers that precise matter was inserted therein for the express purpose of placing the particular question outside of the range of controversy.

‘For a number of years past immigrants have been coming into New Orleans in the autumn from Italy.

‘There was a probability when the general assembly met in 1898 that the epidemic of 1897 might be repeated, and a great probability that immigrants would seek to enter, as they had done the year before, to the great danger, not only of the people of Louisiana, but of the immigrants themselves.

‘Independently of this, there was great danger to be apprehended from the increasing intercourse between New Orleans and the West India islands in consequence of a war with Spain.

‘It was to ward off these dangers that this particular provision was inserted in the act of 1898.’

And by implication from the reasoning just referred to the existence of the conditions rendering it necessary to call the power into play in the case before it was recognized. Thus construing the statute, the state court held that it was not repugnant to the Constitution of the United States and was not in conflict with any law or treaty of the United States. These latter considerations present the questions which arise for our decision. All the assignments of error relied upon to show the *387 invalidity of the statute of the state of Louisiana, and hence the illegality of the action of the board of health from the point of view of Federal considerations, are, in the argument at barsummarized in four propositions. We shall consider them separately and thus dispose of the case. In doing so, however, as the first and second contentions both rest upon the assertion that the statute violates the Constitution of the United States, we shall treat them together.

‘First. The statute drawn in question, on its face and as construed and applied, is void for the reason that it is in violation of art. 1, § 3, ¶ 8, of the Constitution of the United States, inasmuch as it vests authority in the state board of health, in its discretion, to interfere with or prohibit interstate and foreign commerce.

‘Second. The statute is void for inasmuch as it is in conflict with § 1 of the 14th article of Amendment to the Constitution of the United States, in that it deprives the plaintiff of its liberty and property without due process of law, and denies to it the equal protection of the law.’

That from an early day the power of the states to enact and enforce quarantine laws for the safety and the protection of the health of their inhabitants has been recognized by Congress, is beyond question. That until Congress has exercised its power on the subject, such state quarantine laws and state laws for the purpose of preventing, eradicating, or controlling the spread of contagious or infectious diseases, are not repugnant to the Constitution of the United States, although their operation affects interstate or foreign commerce, is not an open question. The doctrine was elaborately examined **815 and stated in Morgan’s L. & T. R. & S. S. Co. v. Louisiana Bd. of Health, 118 U. S. 455, 30 L. ed. 237, 6 Sup. Ct. Rep. 1114. That case involved determining whether a quarantine law enacted by the state of Louisiana was repugnant to the commerce clause of the Constitution because of its necessary effect upon interstate and foreign commerce. The court said:

‘Is the law under consideration void as a regulation of commerce? Undoubtedly it is in some sense a regulation of commerce. It arrests a vessel on a voyage which may have been a long one. It may affect commerce among the states when *388 the vessel is coming from some other state of the Union than Louisiana, and it may affect commerce with foreign nations when the vessel arrested comes from a foreign port. This interruption of the voyage may be for days or for weeks. It extends to the vessel, the cargo, the officers and seamen, and the passengers. In so far as it provides a rule by which this power is exercised, it cannot be denied that it regulates commerce. We do not think it necessary to enter into the inquiry whether, notwithstanding this, it is to be classed among those police powers which were retained by the states as exclusively their own, and, therefore, not ceded to Congress. For, while it may be a police power in the sense that all provisions for the health, comfort, and security of the citizens are police regulations, and an exercise of the police power, it has been said more than once in this court that, even where such powers are so exercised as to come within the domain of Federal authority as defined by the Constitution, the latter must prevail. Gibbons v. Ogden, 9 Wheat, 1, 210, 6 L. ed. 23, 73; Henderson v. New York, 92 U. S. 259, 272, sub nom. Henderson v. Wickham, 23 L. ed. 543; New Orleans Gaslight Co. v. Louisiana Light & H. P & Mfg. Co. 115 U. S. 650, 661, 29 L. ed. 516, 520, 6 Sup. Ct. Rep. 252.

‘But it may be conceded that whenever Congress shall undertake to provide for the commercial cities of the United States, a general system of quarantine, or shall confide the execution of the details of such a system to a national board of health, or to local boards, as may be found expedient, all state laws on the subject will be abrogated, at least so far as the two are inconsistent. But, until this is done, the laws of the state on the subject are valid. This follows from two reasons:

‘1. The act of 1799, the main features of which are embodied in title LVIII. of the Revised Statutes, clearly recognizes the quarantine laws of the states, and requires of the officers of the Treasury a conformity to their provisions in dealing with vessels affected by the quarantine system. And this very clearly has relation to laws created after the passage of that statute, as well as to those then in existence; and when, by the act of April 29, 1878 (20 Stat. at L. 37, chap. 66), certain powers in this direction were conferred on the Surgeon General of the Marine Hospital Service, and consuls and revenue officers were required to contribute *389 services in preventing the importation of disease, it was provided that ‘there shall be no interference in any manner with any quarantine laws or regulations as they now exist or may hereafter be adopted under state laws,’ showing very clearly the intention of Congress to adopt these laws or to recognize the power of the states to pass them.

‘2. But, aside from this, quarantine laws belong to that class of state legislation which, whether passed with intent to regulate commerce or not, must be admitted to have that effect, and which are valid until displaced or contravened by some legislation of Congress.’

Again, in Louisiana v. Texas, 176 U. S. 1, 21, 44 L. ed. 347, 355, 20 Sup. Ct. Rep. 251, 258, the court was called upon to consider a quarantine law of the state of Texas which by its terms was applicable to and was enforced as to both interstate and foreign commerce. After referring approvingly to the case which we have above cited, the court, speaking through Mr. Chief Justice Fuller, said:

‘It is not charged that this statute is invalid, nor could it be if tested by its terms. While it is true that the power vested in Congress to regulate commerce among the states is a power complete in itself, acknowledging no limitations other than those prescribed in the Constitution, and that where the action of the states in the exercise of their reserve powers comes into collision with it, the latter must give way, yet it is also true that quarantine laws belong to that class of state legislation which is valid until displaced by Congress, and that such legislation has been expressly recognized by the laws of the United States almost from the beginning of the government.’

Further, in calling attention to the fact, as remarked by the court in Morgan’s L. & T. R. & S. S. Co. v. Louisiana Bd. of Health, 118 U. S. 455, 30 L. ed. 237, 6 Sup. Ct. Rep. 1114, that in the nature of things quarantine laws and laws relating to public health must necessarily vary with the different localities of the country, it was said:

‘Hence, even if Congress had remained silent on the subject it would not have followed that the exercise of the police power of the state in this regard, although necessarily operating on interstate commerce, would be therefore invalid. Although from the nature and subjects of the power of regulating commerce *390 it must be ordinarily exercised by the national government exclusively, this has not been held to be so where, in relation to the particular subject-matter, different rules might be suitable in different localities. At the same time, Congress could by affirmative action displace the local laws, substitute laws of its own, and thus correct any unjustifiable and oppressive exercise of power by state legislation.’

Despite these conclusive adjudications, it is earnestly insisted in the argument at bar that by a correct appreciation of all the decisions of this court on the subject, the rule **816 will be discovered to be that the states may enact quarantine or other health laws for the protection of their inhabitants, but that such laws, if they operate upon or directly affect interstate or foreign commerce, are repugnant to the Constitution of the United States independently of whether Congress has legislated on such subjects. To sustain this contention a most copious reference is made to many cases decided by this court, where the nature and extent of the power of Congress to regulate commerce was considered and the validity of state legislation asserted to be repugnant to such power was passed upon. To analyze and review the numerous cases referred to in order to point out their want of relation to the question in hand would involve in effect a review of the whole subject of the power of Congress to regulate commerce in every possible aspect, and an analysis of practically the greater body of cases which have in this court involved that serious and difficult subject from the beginning. We shall not undertake to do so, but content ourselves with saying, after duly considering the cases relied upon, that we find them inapposite to the doctrine they are cited to sustain, and hence, when they are correctly appreciated, none of them conflict with the settled rule announced by this court in the cases to which we have referred.

The confusion of thought which has given rise to the misconception of the authorities relied upon in the argument, and which has caused it to be supposed that they are apposite to the case in hand, is well illustrated by the premise upon which the proposition that the cited authorities are applicable rests. That proposition is thus stated in the printed argument (italics in the original):

*391 ‘Turning now to the decisions of this court, it will be found that the basis upon which it has upheld the exclusion, inspection, and quarantine laws of various states, is that criminals, diseased persons and things, and paupers, are not legitimate subjects of commerce. They may be attendant evils, but they are not legitimate subjects of traffic and transportation, and therefore, in their exclusion or detention, the state is not interfering with legitimate commerce, which is the only kind entitled to the protection of the Constitution.’

But it must be at once observed that this erroneously states the doctrine as concluded by the decisions of this court previously referred to, since the proposition ignores the fact that those cases expressly and unequivocally hold that the health and quarantine laws of the several states are not repugnant to the Constitution of the United States, although they affect foreign and domestic commerce, as in many cases they necessarily must do in order to be efficacious, because until Congress has acted under the authority conferred upon it by the Constitution, such state health and quarantine laws producing such effect on legitimate interstate commerce are not in conflict with the Constitution. True it is that, in some of the cases relied on in the argument, it was held that a state law absolutely prohibiting the introduction, under all circumstances, of objects actually affected with disease, was valid because such objects were not legitimate commerce. But this implies no limitation on the power to regulate by health laws the subjects of legitimate commerce. In other words, the power exists until Congress has acted, to incidentally regulate by health and quarantine laws, even although interstate and foreign commerce is affected, and the power to absolutely prohibit additionally obtains where the thing prohibited is not commerce, and hence not embraced in either interstate or foreign commerce. True, also, it was held in some of the cases referred to by counsel, that where the introduction of a given article was absolutely prohibited by a state law upon the asserted theory that the health of the inhabitants would be aided by the enforcement of the prohibition, it was decided that, as the article which it was thus sought to prohibit was a well-known article of commerce, and therefore *392 the legitimate subject of interstate commerce, it could not be removed from that category by the prohibitive effect of state legislation. But this case does not involve that question, since it does not present the attempted exercise by the state of the power to absolutely prohibit the introduction of an article of commerce, but merely requires us to decide whether a state law, which regulates the introduction of persons and property into a district infested with contagious or infections diseases, is void, because to enforce such regulation will burden interstate and foreign commerce, and therefore violate the Constitution of the United States. It is earnestly insisted that the statute, whose constitutionality is assailed, is, on its face, not a regulation, but an absolute prohibition against interstate commerce, and it is sought to sustain this contention by various suggestions as to the wrong which may possibly arise from a perversion and an abuse by the state authorities of the power which the statute confers. Thus it is said, what is an infectious and contagious disease is uncertain, and involves a large number of maladies. How many cases of such malady are essential to cause a place to be considered as infected with them is left to the determination of the board of health. That board, it is argued, may then arbitrarily, upon the existence of one or more cases of any malady which it may deem to be infectious or contagious, declare any given place in the state, or even the whole state of Louisiana, infected, and proceed to absolutely debar all interstate or foreign commerce with the state of Louisiana. True it is, as said in Morgan’s L. & T. R. & S. S. Co. v. Louisiana Bd. of Health, 118 U. S. 455, 30 L. ed. 237, 6 Sup. Ct. Rep. 1114:

‘In all cases of this kind it has been repeatedly held that, when the question is raised whether the state statute is a just exercise of state power or is intended by roundabout means to invade the domain of Federal authority, this court will look into the operation **817 and effect of the statute to discern its purpose. See Henderson v. New York, 92 U. S. 259, 23 L. ed. 543; Chy Lung v. Freeman, 92 U. S. 275, 23 L. ed. 550; Cannon v. New Orleans, 20 Wall. 577, 22 L. ed. 417.

But this implies that we are to consider the statute as enacted and the natural results flowing from it. It does not import that we are to hold a state statute unconstitutional by indulging in *393 conjecture as to every conceivable harm which may arise or wrong which may be occasioned by the abuse of the lawful powers which a statute confers. It will be time enough to consider a case of such supposed abuse when it is presented for consideration. And it is also to be borne in mind, as said by this court in Louisiana v. Texas, 176 U. S. 1, 22, 44 L. ed. 347, 355, 20 Sup. Ct. Rep. 251, 258, if any such wrong should be perpetrated ‘Congress could by affirmative action displace the local laws, substitute laws of its own, and thus correct any unjustifiable and oppressive exercise of power by state legislation.’ And the views which we have previously expressed suffice to dispose of the contention that the subjecting of the vessel of the plaintiff in error to the restriction imposed by the quarantine and health law of the state operated to deprive the defendant in error of its property without due process of law, in violation of the 14th Amendment. It having been ascertained that the regulation was lawfully adopted and enforced, the contention demonstrates its own unsoundness, since in the last analysis it reduces itself to the proposition that the effect of the 14th Amendment was to strip the government, whether state or national, of all power to enact regulations protecting the health and safety of the people, or, what is equivalent thereto, necessarily amounts to saying that such laws when lawfully enacted cannot be enforced against person or property without violating the Constitution. In other words, that the lawful powers of government which the Constitution has conferred may not be exerted without bringing about a violation of the Constitution.

‘Third. The statute as applied and construed is void, for the reason that it is in conflict with treaties between the United States on the one part and the Republic of France and the Kingdom of Italy on the other part, guaranteeing certain rights, privileges, and immunities to the citizens and subjects of said countries.’

Reliance is placed, to sustain this proposition, on the provisions of a treaty concluded with the Kingdom of Italy on February 26, 1871; on the terms of a treaty with Great Britain of July 3, 1815, as also a treaty between the United States and the Kingdom of Greece, concluded December 22, 1837, and one concluded *394 with the Kingdom of Sweden and Norway on July 4, 1827. The treaties of other countries than Italy are referred to upon the theory that as by the treaty concluded with France on April 30, 1803, by which Louisiana was acquired, it was provided that France should be treated upon the footing of the most favored nation in the ports of the ceded territory, therefore the treaties in question made with other countries than France were applicable to the plaintiff in error, a French subject.

Conceding, arguendo, this latter proposition, and therefore assuming that all the treaties relied on are applicable, we think it clearly results from their context that they were not intended to, and did not, deprive the government of the United States of those powers necessarily inhering in it and essential to the health and safety of its people. We say the United States, because if the treaties relied on have the effect claimed for them that effect would be equally as operative and conclusive against a quarantine established by the government of the United States as it would be against a state quarantine operating upon and affecting foreign commerce by virtue of the inaction of Congress. Without reviewing the text of all the treaties, we advert to the provisions of the one made with Greece, which is principally relied upon. The text of article 15 of this treaty is the provision to which out attention is directed, and it is reproduced in the margin.

*395 It is apparent that it provides only the particular form of document which shall be taken by a ship of the Kingdom of Greece and reciprocally by those of the United States for the purpose of establishing that infectious or contagious diseases did not exist at the point of departure. But it is plain from the face of the treaty that the provision as to the certificate was not intended to abrogate the quarantine power, since the concluding section of the article in question expressly subjects the vessel holding the certificate to quarantine detention if, on its arrival, a general quarantine had been established against all ships coming from the port whence the vessel holding the certificate had sailed. In other words, the treaty having provided the certificate and given it effect under ordinary conditions, proceeds to subject the vessel holding the certificate **818 to quarantine, if, on its arrival, such restriction had been established in consequence of infection deemed to exist at the port of departure. Nothing in the text of the treaty, we think, gives even color to the suggestion that it was intended to deal with the exercise by the government of the United States of its power to legislate for the safety and health of its people or to render the exertion of such power nugatory by exempting the vessels of the Kingdom of Greece, when coming to the United States, from the operation of such laws. In other words, the treaty was made subject to the enactment of such health laws as the local conditions might evoke not paramount to them. Especially where the restriction imposed upon the vessel is based, not upon the conditions existing at the port of departure, but upon the presence of an infectious or contagious malady at the port of arrival within the United States, which, in the nature of things, could not be covered by the certificate relating to the state of the public health at the port whence the ship had sailed.

‘Fourth. The statute as applied is void for the reason that it is in conflict with the laws of the United States relating to foreign immigration into the United States.’

In the argument at bar this proposition embraces also the claim that the statute is void because in conflict with the act of Congress of 1893 entitled ‘An Act Granting Additional Quarantine Powers and Imposing Additional Duties upon the Marine *396 Hospital Service.’ 27 Stat. at L. 449, chap. 114. And that it also is in conflict with the rules and regulations adopted for the enforcement of both the immigration laws and the quarantine law referred to.

The immigration acts to which the proposition relates are those of March 3, 1875, of August 3, 1882, of June 26, 1884, of February 26, 1885, of February 23, 1887, and March 3, 1891, and the regulations to enforce the same. Without undertaking to analyze the provisions of these acts, it suffices to say that, after scrutinizing them, we think they do not purport to abrogate the quarantine laws of the several states, and that the safeguards which they create and the regulations which they impose on the introduction of immigrants are ancillary, and subject to such quarantine laws. So far as the act of 1893 is concerned, it is manifest that it did not contemplate the overthrow of the existing state quarantine systems and the abrogation of the powers on the subject of health and quarantine exercised by the states from the beginning, because the enactment of state laws on these subjects would, in particular instances, affect interstate and foreign commerce. An extract from § 3 of the act, which we think makes these conclusions obvious, is reproduced in the margin.

*397 Nor do we find anything in the rules and regulations adopted by the Secretary of the Treasury in execution of the power conferred upon him by the act in question giving support to the contention based upon them. It follows from what has been said that the Supreme Court of Louisiana did not err in deciding that the act in question was not repugnant to the Constitution of the United States, and was not in conflict with the acts of Congress or the treaties made by the United States which were relied upon to show to the contrary and its judgment is therefore affirmed.

 

Mr. Justice Brown, with whom was Mr. Justice Harlan, dissenting:

The power of the several states, in the absence of legislation by Congress on the subject, to establish quarantine regulations, to prohibit the introduction into the state of persons infected *398 with disease, or recently exposed to contagion, and to impose a reasonable charge upon vessels subjected to examination at quarantine stations, is so well settled by repeated decisions of this court as to be no longer open to doubt. This case, however, does not involve that question, but the broader one, whether, in the assumed exercise of this power, the legislature may declare certain portions of the state to be in quarantine, and prohibit the entry therein of all persons whatsoever, whether coming from the United States or foreign countries, from infected or uninfected ports, whether the persons included are diseased or have recently been exposed to contagion, or are perfectly sound and healthy, and coming from ports in which there is no suspicion of contagious diseases.

I have no doubt of the power to quarantine all vessels arriving in the Mississippi from foreign ports for a sufficient length of time to enable the health officers to determine whether there are among her passengers any persons afflicted with a contagious disease. But the state of Louisiana undertakes to do far more than this. It authorizes the state board of health, at its discretion, to ‘prohibit the introduction into any infected portion of the state of persons acclimated, unacclimated, or said to be immune, when in its judgment the introduction of said persons would add to or increase the prevalence of the disease;’ and at its meeting on September 29, 1898, the board of health adopted the following resolution:

‘That hereafter, in the case of any town, city, or parish of Louisiana being declared in quarantine, no body or bodies of people, immigrants, soldiers, or others shall be allowed to enter said town, city, or parish so long as said quarantine shall exist, and that the president of the board shall enforce this resolution.’

**819 In other words, the board of health is authorized and assumes to prohibit in all portions of the state which it chooses to declare in quarantine, the introduction or immigration of all persons from outside the quarantine district, whether infected or uninfected, sick or will, sound or unsound, feeble or healthy; and that, too, not for the few days necessary to establish the sanitary status of such persons, but for an indefinite and possibly *399 permanent period. I think this is not a necessary or proper exercise of the police power, and falls within that numerous class of cases which hold that states may not, in the assumed exercise of police power, interfere with foreign or interstate commerce.

The only excuse offered for such a wholesale exclusion of immigrants is, as stated by the supreme court, ‘to keep down, as far as possible, the number of persons to be brought within danger of contagion or infection, and by means of this reduction to accomplish the subsidence and suppression of the disease, and the spread of the same.’ In other words, the excuse amounts to this: that the admission, even of healthy persons, adds to the possibility of the contagion being communicated upon the principle of adding fuel to the flame. It does not increase the danger of contagion by adding infected persons to the population, since the bill avers that all the immigrants were healthy and sound. All it could possibly do is to increase the number of persons who might become ill if permitted to be added to the population. This is a danger, not to the population, but to the immigrants. It seems to me that this is a possibility too remote to justify the drastic measure of a total exclusion of all classes of immigrants, and that the opinion of the court is directly in the teeth of Hannibal & St. J. R. Co. v. Husen, 95 U. S. 465, 24 L. ed. 527, wherein a state statute, which prohibited the driving or conveying of any Texas, Mexican, or Indian cattle into the state, between March 1 and November 1 in each year, was held to be in conflict with the commerce clause of the Constitution. Such statute was declared to be more than a quarantine regulation, and not a legitimate exercise of the police power of the state. Said Mr. Justice Strong (p. 472, L. ed. 530): ‘While we unhesitatingly admit that a state may pass sanitary laws, and laws for the protection of life, liberty, health, or property within its borders; while it may prevent persons and animals suffering under contagious or infectious diseases, or convicts, etc., from entering the state; while, for the purpose of self-protection, it may establish quarantine and reasonable inspection laws,—it may not interfere with the transportation into or through the state, beyond what is absolutely necessary *400 for its self-protection. It may not, under the cover of exerting its police powers, substantially prohibit or burden either foreign or interstate commerce.’ The statute was held to be a plain intrusion upon the exclusive domain of Congress; that it was not a quarantine law; not an inspection law, and was objectionable because it prohibited the introduction of cattle, no matter whether they may do an injury to the inhabitants of a state or not; ‘and if you do bring them in, even for the purpose of carrying them through the state without unloading them, you shall be subject to extraordinary liabilities.’ Cases covering the same principle are those of State v. The Constitution, 42 Cal. 578, 10 Am. Rep. 303, and Bangor v. Smith, 83 Me. 422, 13 L. R. A. 686, 22 Atl. 379.

I am also unable to concur in the construction given in the opinion of the court to the treaty stipulation with France and other foreign powers. The treaty with France of 1803 provides that ‘the ships of France shall be treated upon the footing of the most favored nations in the ports above mentioned’ of Louisiana. Article 15 of the treaty with Greece of December 22, 1837, set forth in the opinion, provides that vessels arriving **820 directly from the Kingdom of Greece at any port of the United States of America, ‘and provided with a bill of health granted by an officer having competent power to that effect at the port whence such vessel shall have sailed, setting forth that no malignant or contagious diseases prevailed in that port, shall be subjected to no other quarantine than such as may be necessary for the visit of the health officer of the port where such vessels shall have arrived, after which said vessels shall be allowed immediately to enter and unload their cargoes: Provided always, That there shall be on board no person who, during the voyage, shall have been attacked with any malignant or contagious diseases; that such vessels shall not, during their passage, have communicated with any vessel liable itself to undergo a quarantine; and that the country whence they came shall not at that time be so far infected or suspected that, before their arrival, an ordinance had been issued in consequence of which all vessels coming from that country should be considered as suspected, and consequently subject to quarantine.’

*401 If the law in question in Louisiana, excluding French ships from all access to the port of New Orleans, be not a violation of the provision of the treaty that vessels ‘shall be subjected to no other quarantine than such as may be necessary for the visit of the health officer of the port where such vessels shall have arrived, after which said vessels shall be allowed immediately to enter and unload their cargoes,’ I am unable to conceive a state of facts which would constitute a violation of that provision. Necessary as efficient quarantine laws are, I know of no authority in the states to enact such as are in conflict with our treaties with foreign nations.

All Citations

186 U.S. 380, 22 S.Ct. 811, 46 L.Ed. 1209

Footnotes

 

 

‘Article 15. It is agreed that vessels arriving directly from the United States of America at a port within the dominions of His Majesty the King of Greece, or from the Kingdom of Greece, at a port of the United States of America, and provided with a bill of health granted by an officer having competent power to that effect at the port whence such vessel shall have salled, setting forth that no malignant or contagious diseases prevailed in that port, shall be subjected to no other quarantine than such as may be necessary for the visit of the health officer of the port where such vessel shall have arrived, after which said vessels shall be allowed immediately to enter and unload their cargoes; Provided always, that there shall be on board no person who, during the voyage, shall have been attacked with any malignant or contagious disease; that such vessels shall not, during the passage, have communicated with any vessel liable itself to undergo a quarantine; and that the country whence they came shall not at that time be so far infected or suspected that, before their arrival, an ordinance had been issued in consequence of which all vessels coming from that country should be considered as suspected, and consequently subject to quarantine.’ [8 Stat. at. L. 506.]

 

 

‘Sec. 3. That the Supervising Surgeon General of the Marine Hospital Service shall, immediately after this act takes effect, examine the quarantine regulations of all state and municipal boards of health, and shall, under the direction of the Secretary of the Treasury, cooperate with and aid state and municipal boards of health in the execution and enforcement of the rules and regulations of such boards and in the execution and enforcement of the rules and regulations made by the Secretary of the Treasury, to prevent the introduction of contagious or infectious diseases into the United States from foreign countries, and into one state or territory or the District of Columbia from another state or territory or the District of Columbia; and all rules and regulations made by the Secretary of the Treasury shall operate uniformly and in no manner discriminate against any port or place; and at such ports and places within the United States as have no quarantine regulations under state or municipal authority, where such regulations are, in the opinion of the Secretary of the Treasury, necessary to prevent the introduction of contagious or infectious diseases into the United States from foreign countries, or into one state or territory or the District of Columbia from another state or territory or the District of Columbia, and at such ports and places within the United States where quarantine regulations exist under the authority of the state or municipality which, in the opinion of the Secretary of the Treasury, are not sufficient to prevent the introduction of such diseases into the United States, or into one state or territory or the District of Columbia from another state or territory or the District of Columbia, the Secretary of the Treasury shall, if in his judgment it is necessary and proper, make such additional rules and regulations as are necessary to prevent the introduction of such diseases into the United States from foreign countries, or into one state or territory or the District of Columbia from another state or territory or the District of Columbia, and when said rules and regulations have been made they shall be promulgated by the Secretary of the Treasury and enforced by the sanitary authorities of the states and municipalities, where the state or municipal health authorities will undertake to execute and enforce them; but if the state or municipal authorities shall fail or refuse to enforce said rules and regulations the President shall execute and enforce the same and adopt such measures as in his judgment shall be necessary to prevent the introduction or spread of such diseases, and may detail or appoint officers for that purpose. The Secretary of the Treasury shall make such rules and regulations as are necessary to be observed by vessels at the port of departure and on the voyage, where such vessels sail from any foreign port or place to any port or place in the United States, to secure the best sanitary condition of such vessel, her cargo, passengers, and crew, which shall be published and communicated to and enforced by the consular officers of the United States.’

 

 

End of Document

 

© 2020 Thomson Reuters. No claim to original U.S. Government Works.

 

 

 

7.2 Jacobson v. Massachusetts 7.2 Jacobson v. Massachusetts

JACOBSON v. MASSACHUSETTS.

ERROR TO THE SUPREME COURT OP THE STATE OP MASSACHUSETTS.

No. 70.

Argued December 6, 1904.

Decided February 20, 1905.

The' United States does not derive any of its substantive powers from the Preamble of the.Constitution. It cannot exert any power to secure the declared objects of the Constitution unless, apart from the Preamble such power be found in', or can properly be implied from, some express delegation-in the instrument.

While the spirit of the Constitution is to be respected not less than its letter, the spirit, is to be collected chiefly from its words.

While the exclusion of evidence in the state court in a case involving the constitutionality of a state statute may not strictly present a Federal question, this court may consider the rejection of such evidence upon the ground of incompetency, or immateriality under the statute as showing its scope and meaning in the opinion of the state court.

The police^ power of a State embraces such reasonable regulations relating to matters completely within its territory, and not affecting the people of other States, established directly by legislative enactment, as will protect the public health and safety.

While a local regulation, even if based on the acknowledged police power of a State, must always yield in case of conflict with the exercise by the General Government of any power it possesses under the Constitution, the mode or manner of exercising its police power is wholly within the discretion of the State so long as the Constitution of the United States is not contravened, or any right granted or secured thereby is not infringed, or not exercised in such an arbitrary and oppressive manner as to justify the interference of the courts to prevent wrong and oppression.

The liberty secured by the Constitution of the United States does not import an absolute right in each person to be at all times, and in all circumstances wholly freed from restraint, nor is it an element, in such liberty that one. person, or a minority of persons residing in any com- ■ munity and enjoying the benefits of its local government, should have power to dominate the majority when supported in their action by the authority of the State.

It is within the police power of a State to enact a compulsory vaccination law, and it is for the legislature, and not for the courts, to determine *12in the first instance whether vaccination is or is not the best mode for the prevention of smallpox and the protection of the public health.

There being obvious reasons for such exception, the fact that children, under certain circumstances, are excepted from the operation of the law does not deny the equal protection of the laws to adults if the statute is applicable equally to all adults in like condition.

The highest court of Massachusetts not having held that the compulsory vaccination law of that State establishes the absolute rule that an adult must be vaccinated even if he is not a fit subject at the time or that vaccination would. seriously injure his health or cause his death, this court holds that as to an adult residing in the community, and a fit subject of vaccination, the statute is not invalid as in derogation of any of the rights of such person under the Fourteenth Amendment.

This case involves the validity, under the Constitution of the United States, of certain provisions in the statutes of Massachusetts relating to vaccination.

The Revised Laws of that Commonwealth, c. 75, § 137, provide that “the board of health Of a city Or town if, in its opinion, it is necessary for the public health or safety shall require and enforce the vaccination and revaccination of all the inhabitants thereof and shall provide them with the means of free vaccination. Whoever, being over twenty-one years of age and not under guardianship, refuses or neglects to comply with . súch requirement shall forfeit five dollars.”

An exception is made in favor of “children who present a certificate, signed by a registered physician that they are unfit subjects for vaccination.” § 139.

Proceeding under the above statutes, the Board of Health of the city of Cambridge, Massachusetts, on the twenty-seventh day of February, 1902, adopted the following regulation: “Whereas, smallpox has been prevalent to some extent in the city of Cambridge and still continues to increase; and whereas, it is necessary for the speedy extermination of the disease, that all persons not protected by vaccination should be vaccinated; and whereas, in the opinion of the board, the public health and safety require the vaccination or revaccination of all the inhabitants of Cambridge; be it ordered, that *13all thé inhabitants óf the city who have not been successfully, vaccinated since March 1,1897, be vaccinated or revaccinated.”

Subsequently, the Board adopted an additional regulation empowering a named physician to enforce the vaccination of persons as directed by the Board at its special meeting of February .27.

The above regulations being in force, the plaintiff in error, Jacobson, was proceeded against by a criminal complaint in one of the inferior courts of Massachusetts. The complaint charged that on the seventeenth day of July, 1902, the Board of Health of Cambridge, being of the opinion that it was necessary for the public health and safety, required the vaccination and revaccination of all the inhabitants thereof who had not been successfully vaccinated since the first day of. March, 1897, and provided them with the means of free vaccination, and that the defendant, being over twenty-one years of age and not under guardianship, refused and neglected to comply with such requirement.

The defendant, having been arraigned, pleaded not guilty. The government put in evidence the above regulations adopted by the Board of Health and made proof tending to show that > its chairman informed the defendant that by refusing to be vaccinated he would incur the .penalty provided by the statute, and would be prosecuted therefor; that he offered to vaccinate the defendant without expense to him; and that the offer was declined and defendant refused to be vaccinated.

The .prosecution having introduced no other evidence, the defendant made numerous offers of proof. But the trial court ruled that each and.all of the facts offered to be proved by the ., defendant were immaterial, and excluded all proof of them.

The defendant, standing upon his offers of proof, and im troducing no evidence, asked numerous instructions to the jury, among which were the following:

That section 137 of chapter 75 of the.Uevised' Laws of Massachusetts was in derogation- of the rights secured to the defendant by' the Preamble to the Constitution of the United *14States, and tended to subvert and defeat thé purposes of the Constitution as declared in its Preamble;

That the section referred to was in derogation of the rights secured to the defendant by the Fourteenth Amendment of the. Constitution of the United States, and. especially of the clauses of that amendment providing that no State shall make or enforce any law abridging' the privileges or immunities' of citizens of the United States, nor deprive any person of life, liberty or property without due process of law, nor deny to any person within its jurisdiction the equal protection of .the laws; and

That said section was opposed to the spirit of the Com stitution.

.Each of the defendant’s prayers for instructions was rejected, and he duly excepted. The defendant requested the court, but the court refused, to instruct the jury to return a verdict of not guilty. And the court instructed .the jury in substance that if they believed the evidence introduced by the Commonwealth and were satisfied beyond a reasonable doubt that the defendant was guilty of the offense charged in the complaint, they would be warranted' in finding a verdict of guilty. A verdict of guilty was thereupon returned.-:

The case was then continued for the opinion of the Supreme Judicial Court of Massachusetts. That -court overruled all the defendant’s exceptions, sustained the action of the trial court, and thereafter, pursuant to the.verdict- of the jury, he' was sentenced by the court to pay a firth of five dollars. And the court ordered -that he stand committed until the fine was paid. .■

Mr. George Fred Williams, with whom Mr. James A. Hallaran was on the brief, for plaintiff in error:

The right of the State under police power to enforce'vaccination upon its inhabitants has not yet been determined, or more than remotely considéred by this court; references are made to it in Lawton v. Steele, 152. U. S. 133; Hannibal & *15St. J. R. R. Co. v. Husen, 95 U. S. 465; Am, School of Healing v. McAnnulty, 187 U. S. 94. The plaintiff in error knows of no other cases ‘in which the subject of vaccination has been considered by this court. From a summary of vaccination laws and vaccination statutes in the United States it appears that thirty-four States of the Union have no compulsory vaccination law, as follows: Alabama, • Arkansas, California, Colorado, Delaware, Florida, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine,. Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Dakota, Ohio, Oregon, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, West Virginia and Wisconsin.

Compulsory vaccination exists in eleven States, as follows: Connecticut, Georgia, Kentucky, Maryland (of children), •Massachusetts, Mississippi, North Carolina, Pennsylvania (in second class cities), South Carolina, Virginia and Wyoming. In thirteen States exclusion of unvaccinated children from the public schools is provided, as follows: California, Georgia, Iowa, Maine, Massachusetts, New Hampshire, New Jersey, New York, Oregon, Pennsylvania; Rhode. Island, South' Dakota and Virginia.

Three-quarters of the States have not entered upon the policy of enforcing vaccination by legal penalty/ Not one of the States undertakes forcible vaccination, while Utah and West Virginia expressly provide that no such compulsion shall be used.

Smallpox has ceased to be the scourge which it once was, and there is a growing tendency" to resort to sanitation and isolation rather than vaccination. The States which make no provision for vaccination are not any more afflicted with smallpox than those which, compel vaccination. Even New York, which imports the major part of the immigrants who annually enter this country, has not undertaken to force it upon the people. As to other countries, the Queen "of Holland has recently recommended the repeal of the compulsory vac*16cination laws. There are no vaccination laws in New Zealand, and Switzerland has by plebiscite abolished all compulsory vaccination.

The English law, 61 & 62 Viet., ch. 49, .provides only for the vaccination of children, under a penalty, and furnishes to the people a . special vaccinator.

See ch. 299, Laws of Minnesota of 1903, abolishing vaccination, and veto in 1901 of Governor La Follette of vaccination law of Wisconsin. In 1904 there were riots in Brazil arising from attempts to enforce vaccination.

For decisions of state courts involving vaccination laws which have mainly been decided upon statutes relating to the exclusion of children from the public schools see Bissell v. Davison, 65 Connecticut, 183; Abeel v. Clark, 84 California, 226; State v. Zimmerman, 86 Minnesota, 353; Osborn v. Russell, 64 Kansas, 507; Potts v. Breen, 167 Illinois, 67; Duffield v.Williamsport School District, 162 Pa. St. 476; State v. Burdge, 95 Wisconsin, 390; Re Rebenack, 62 Mo. App. 8; Blue v. Beach, 155 Indiana, 121. The only cases which have considered general' compulsory vaccination laws are State v. Hay, 126 N. Car. 999; Morris v. Columbus, 102 Georgia, 792; Re William H. Smith, 146 N. Y. 68.

None of these cases are as extreme as the decision in the case . at bar and the laws providing that unvaccinated children shall not attend the public schools are widely variant from laws compelling the vaccination of adult citizens.

As to admitted functions of the police power, see 4 Blackstone, 162; Cooley’s Const. Lim. 704; Han. & St. Jo. R. R. Co. v. Husen, 95 U. S. 465, 470; but the power is for the security of liberty and not for oppression. Barbier v. Connelly, 113 U. S. 27; Lawton v. Steele, 152 U. S. 133.

A compulsory vaccination law is unreasonable, arbitrary and oppressive; it is only effective in the protection of lawbreakers; the legal penalty is illogical and unjust. See under English Act, 30 & 31 Viet., ch. 84, extent of penalties. Regina *17v. Justice, L. R. 17 Q. B. D. 191; Dutton v. Atkinson, L. R. 6 Q. B. 373; Pitcher v. Stafford, 4 Vest. & S. 775; Allen v. Worthy, L. R. 5. Q. B. 163; Tebb v. Jones, 37 L. T. (N. S.) 576. The law is not of general application as children are exempted. Compulsion to introduce disease into a healthy system is a violation of liberty. The right to preserve life is the most sacred .right of man, Slaughter House Cases, 16 Wall. 36, and is specially provided for in the Preamble of the Federal Constitution. If injured the person vaccinated is damaged without compensation. Miller v. Horton,. 152 Massachusetts, 546. The law is not within any cognizable principle of criminal law. 1 Bishop, §§204, 230, 490; 513; Commonwealth v. Thompson, 6 Massachusetts, 134. The exemptions are unconstitutional-. Minors are exempt while adults are penalized. The classification is not a reasonable one. M., K. & T. Ry. Co. v. May, 194 U. S. 267; Gulf, Colo. & S. F. v. Ellis, 165 U. S. 150.

Plaintiff in error offered to show that he had suffered serioúsly-. from previous vaccination, thus indicating that his system was sensitive to the poison of vaccination virus. The like illness of his son indicated that a hereditary condition existed which would cause the system to rebel against the introduction of the vaccine matter. If the plaintiff in error had offered the opinion of a physician that vaccination might even be deadly in its effects upon the plaintiff, the law recognized no such defense, and the evidence must-have been excluded. The law itself testifies to its own oppressive and unreasonable character. It is not due process of law, when such defense is excluded. It is not equal protection of the laws, when such defense is open to parents for the protection of children and is not open to parents themselves. The right' is of such an important and fundamental character as to deprive plaintiff of his liberty without due process of law. West v. Louisiana, 194 U. S. 258, 262.

The Board of Health is entrusted with arbitrary powers, and determines the necessity for, and methods of, vaccination *18and plaintiff's rights in regard thereto without a hearing, thus depriving.him of his liberty without due process of law. Chi., M. & St. P. v. Minnesota, 134 U. S. 418; Hagan v. Reclamation Dist., 111 U. S. 701.

The law is not justified by necessity. Miller v. Horton, 152 Massachusetts, 546; Am. School of Healing, v. McAnnulty, 187 U. S. 94.

Plaintiff in error- was entitled to show the facts, as -they existed' about vaccination' and its effects. •'

Mr. Frederick H. Nash, with whom Mr. Herbert Parker, •.Attorney General of the State of Massachusetts, was on the brief, for defendant, in error:

■ It is no argument that the- conviction was repugnant +0 the spirit or to the Preamble qf the. Constitution. Ah. act of the legislature .of, a State and' regular- proceedings under it are to -be overthrown only by virtue-of some'specific prohibition in the paramount law. Forsythe v. City of Hammond, 68 Fed; Rep. 774; Walker v. Cincinnati, 21 Ohio St. 14, 41 ; State v. Staten, 6 Coldwell, 233, 252 ; State v. Gerhardt, 145 Indiana, 439, 450; State v. Smith, 44 Ohio St. 348, 374; People v. Fisher, 24 Wend 214, 219; Redell v. Moores, 63 Nebraska, 219, overruling State v. Moores, 55 Nebraska, 480. The Fifth Amendment does not apply to action by. a State. Barron v. Baltimore, 7 Pet. 243, 247; Eilenbecker v. Plymouth Co., 134 U. S. 31; McElvaine v. Brush, 142 U. S. 155, 158; Brown v. New Jersey, 175 U. S. 172; Capital City Dairy Co. v. Ohio, 183 U. S. 238; Lloyd v. Dollison, 194 U. S. 445.

It is now too late, to- argue that the provisions of the Fifth Amendment, securing the fundamental rights of the individual as against the exercise of Federal power, are by virtue ~of the Fourteenth Amendment- to be regarded as privileges and immunities of a citizen of the United. States. Slaughter House Cases, 16 Wall. 36; Maxwell v.Dow, 176 U. S. 581.

The privileges and immunities of the plaintiff in error except where he comes in contact with the machinery of the *19Federal Government, are those which his own State gives him. In his relations with his State he takes no benefit from the Fifth Amendment or from the Preamble of the United States Constitution.

In its unquestioned power to preserve and protect the public health, it is for the legislature of each State to determine whether vaccination is effective in preventing the spread of smallpox, or-not, and deciding in the affirmative to require doubting individuals to yield for the welfare of the community. In re Smith, 146 N. Y. 68, 77; Powell v. Pennsylvania, 127 U. S. 678, 683.

The statute in the present case was enacted as a health measure, and has a real and substantial relation to that object. , Compare, by contrast, the statute forbidding the manufacture of cigars in tenement-houses, In re Jacobs, 98 N. Y. 98, the statute forbidding people to give away articles in connection with a sale of food, People v. Gillson, 109 N. Y. 389, and the statute forbidding bakers’ employes to work more than ten hours a day, People v. Lochner, 177 N. Y. 145. Dissenting opinion.

Only in such cases of legislative dissimulation is it held that a law, apparently looking to the protection of the public health and working without undue classification, is a violation of the Fourteenth Amendment. Mugler v. Kansas, 123 U. S. 623; Sentell v. New Orleans &c. Ry. Co., 166 U. S. 698, 704, 705; Hawker v. New York, 170 U. S. 189, 192; Holden v. Hardy, 169 U. S. 366.

In Lawton v. Steele, 152 U. S. 133, 136, it is said, By way of illustration, that compulsory vaccination is a proper exercise of the police power,'see also Morris v. City of Columbus, 102 Georgia, 792, and State v. Hay, 126 N. Car. 999.

The courts may not listen to conflicting expert testimony as -to the efficacy or hurtfulness of vaccination in general. The legislature is the only body which has power to determine whether the anti-vaccinationists or the majority of the medical profession are in the right.

*20That the legislature has large discretion to determine what personal sacrifice the public health, morals and safety require from individuals is elementary. Cases cited supra, and Booth v. Illinois, 184 U. S. 425; Austin v. Tennessee, 179 U. S. 343; Fertilizing Co. v. Hyde Park, 97 U. S. 659.

The legislature of Massachusetts has.power to require the vaccination of its inhabitants and fix appropriate penalties for refusal. As to the form of the legislation arid its application to the plaintiff in error, the exception of minors and wards from the provisions of the statute, rests upon a reasonable basis of classification and denies to nobody' the equal protection of the laws. The advantage of uniform and general laws is best attained by vesting discretionary power in local administrative bodies. Wilson v. Eureka City, U. S. 32; Health Department v. Rector of Trinity Church, 145 N. Y. 32.

A perfectly equal law may easily be the most unjust. A statute requiring the vaccination of all the inhabitants of a State at a specified time irrespective of the presence of -smallpox and without regard to individual conditions of health, or a set of rules and regulations- made by the legislature itself, which must necessarily be more or less inelastic, would be far less just than this statute which delegates 'discretion 4;o local public officials. It is wise legislation which leavés the necessity for general vaccination and the-decision as to the time for vaccination of each individual to the local boards of health. If they act in an arbitrary manner, depriving any individual of a right protected by the Fourteenth Amendment, their action in such individual case is void. Thus the law in general stands, but particular cases of oppression may be prevented. Compare Yick Wo v. Hopkins, 118 U. S. 356, and Jew Ho v. Williamson, 103 Fed. Rep. 10, with Williams v. Mississippi, 170 U. S. 213; Ex parte Virginia, 100 U. S. 339; Carter v. Texas, 177 U. S. 442; Tarrence v. Florida, 188 U. S. 519.

The order of the Board of Health is clearly within the authority of the statute. Matthews v. Board of Education, 127 *21Michigan, 530; Potts v. Breen, 167 Illinois, 67; State v. Burdge, 95 Wisconsin, 390; Lawbaugh v. Board of Education, 177 Illinois, 572; In re Smith, 146 N. Y. 68; Wong Wai v. Williamson, 103 Fed. Rep. 1; Wilson v. Alabama &c. R. R. Co., 77 Mississippi, 714; Hurst v. Warner, 102 Michigan, 238, distinguished, as the rules were held to be broader than the statute. And see where regulations were sustained, Field v. Bobinson, 198 Pa. St. 638; State v. Board of Education, 21 Utah, 401; Blue v. Beach, 155 Indiana, 121; Bissell v. Davidson, 65 Connecticut, 183; Morris V. City of Columbus, 102 Georgia, 792. In State v. Hay, 126. N. Car. 999, the court observed that if the jury had found that the defendant’s health made it unsafe for him to be vaccinated that would-be a sufficient excuse for his non-compliance, since to vaccinate him under such conditions would be an arbitrary and unreasonable enforcement of the statute. See also Abeel v. Clark, 84 California, 226; State v. Bell, 157 Indiana, 25; State v. Zimmerman, 86 Minnesota, 353; Matter of Walters, 84 Hun, 457.

The action taken by the Board of Health in the case of the plaintiff in error did not infringe his rights under the Federal Constitution. Arbitrary action by the Board of Health, “with evil mind,” might result in a denial of due process of law. If they picked out one class of persons arbitrarily for immediate vaccination, while indefinitely postponing action toward all others, or if they otherwise abused their discretion their action might be in violation of the Fourteenth Amendment, cases cited supra, but there is no suggestion of arbitrary conduct. It is not even hinted that in the exercise of their discretion they failed to make proper discrimination as to temporary conditions. If ther.e were special reasons why the plaintiff in error could not be vaccinated at the time required by the Board of Health, he should have made them a ground of his refusal; and, if the Board neglected to consider them, a defense to his prosecution. Penn. R. R. Co. v. Jersey City, 47 N. J. L. 286. The statute did not require the vaccination and revaccination of all the inhabitants, without discrimination, *22but left the matter to the discretion of the local authorities. This was an unobjectionable method of legislation. Field v. Clark, 143 U. S. 649, 693, 694.

Mr. Justice Harlan,

after making the foregoing statement, delivered the opinion of the court.

We pass without extended discussion the suggestion that the particular section of the statute of Massachusetts now in question (§ 137, c. 75) is in derogation of rights secured by the Preamble of the Constitution of the United States. Although'that Preamble indicates the. general purposes for which the people ordained and established the Constitution,. it has never been regarded as the source of any substantive power conferred on the Government of the United States or on any of its Departments. Such powers embrace only those expressly granted in the body of the Constitution and such as may be implied from those, so granted. Although, therefore, one of the declared objects of the. Constitution was to secure the blessings of liberty to all under the sovereign jurisdiction and authority of the United States, no power can be exerted to that end by the United States unless, • apart from the Preamble, it be found in some express delegation of power or in some power to be properly implied therefrom. 1 Story’s Const. § 462.

We also pass without discussion the suggestion that the above section of the statute is opposed to the spirit of the Constitution. ’ Undoubtedly, ás observed by Chief Justice Marshall, speaking for the court in Sturges v. Crowninshield, 4 Wheat. 122, 202, “the spirit of an instrument, especially of a constitution, is to be respected not less than its letter, yet the spirit is to be collected chiefly from its words.” ' We have no need in this case to go beyond the plain, obvious meaning of the words in those provisions of the Constitution which, it is contended, must control our decision.

What, according to the judgment of the state court, is the *23.scope ánd-effect of the statute? What results were intended to be accomplished by it? These questions must be answered.

The Supreme Judicial Court .of Massachusetts said in the present case: “Let us consider the offer of evidence which was made by the defendant Jacobson. The ninth of the propositions which he offered to prove, as to what vaccination consists of, is nothing more than a fact of common knowledge, upon which the statute is founded, and proof of it was unnecessary and immaterial. The thirteenth and fourteenth involved matters depending upon his personal opinion, which could not be taken as correct, or given 'effect, merely because he made it a ground of refusal to comply with the requirement. Moreover, his views could not affect the validity of the statute, nor entitle him to be excepted from its provisions. Commonwealth v. Connelly, 163 Massachusetts, 539; Commonwealth v. Has, 122 Massachusetts, 40; Reynolds v. United States, 98 U. S. 145; Regina v. Downes, 13 Cox C. C. 111. The other eleven .propositions all relate to alleged injurious or dangerous effects of vaccination. The defendant ‘offered to prove and show by competent evidence’ these so-called facts. Each of them, in its nature, is such that it cannot be stated as a truth, otherwise than as a matter of opinion. The only ‘competent evidence’ that could be presented to the court to prove these propositions was the testimony of experts, giving their opinions. It would not have been competent to introduce the medical history of individual cases. Assuming that medical experts'could have been found who would have testified in support of these propositions, and that it had become the duty of the judge, in accordance with the law as stated in Commonwealth v. Anthes, 5 Gray, 185, to instruct the jury as to whether or not the statute is constitutional, he would have been obliged to consider the evidence in connection with facts of common knowledge, which the court will always regard in passing upon the constitutionality of a statute. • He would have considered this testimony of experts in connection with the facts that for nearly a century most of the members of the medical profession *24have regarded vaccination, repeated after intervals, as a preventive of smallpox; that while they have recognized the possibility of injury to an individual from carelessness in the performance of it, or even in a conceivable, case without carelessness, they generally have considered the risk of such an' injury too small to be seriously weighed as against the benefits coming from the discreet and proper use of the preventive; and that not only the medical profession and the people generally have for . a long time entertained these opinions, but legislatures and courts have acted upon them with general unanimity. If the defendant had been permitted to introduce such expert testimony as he had in support of these several propositions, it could not have changed the result. It would' not have justified the court in holding that- the legislature had transcended its power in enacting this statute, on their judgment of what the welfare of the people demands.” Commonwealth v. Jacobson, 183 Massachusetts, 242.

-. While the mere rejection of defendant’s offers of proof does not strictly present a Federal question, we may properly regard the. exclusion of evidence upon the ground of its irico'mpetency or immateriality under the statute as showing what, in “the opinion of the state court, is the scope and meaning of the statute. Taking the above observations of the state' court as indicating the scope of the statute — and such is our duty, Leffingwell v. Warren, 2 Black, 599, 603, Morley v. Lake Shore Railway Co., 146 U. S. 162 167, Tullis v. L. E. & W. R. R. Co., 175 U. S. 348, W. W. Cargill Co. v. Minnesota, 180 U. S. 452, 466—we assume for the purposes of the present inquiry that its provisions require, at least1 as a general rule", that adults not under guardianship and remaining within the limits of the city of Cambridge must submit, to the regulation adopted by the Board of Health. Is the statute, so construed, therefore, inconsistent with the liberty which "the Constitution of the United States secures to every person*'against deprivation by the State? . ’

The authority of the State to enact this statute is to be *25referred to what is commonly called the police power — a power which the State did not surrender when becoming a member of the Union under .the Constitution. Although this court has refrained from any attempt to define the limits of that power, yet it has distinctly recognized the authority of a State to enact .quarantine laws and “health-laws of every description;” indeed, all laws that relate to matters completely within its territory and which do not by their, necessary operation affect the people of other States. According to settled principles the police power of a State must be held to embrace, at least, such reasonable regulations established directly by legislative enactment as will protect the publi'c health and the public safety. Gibbons v. Ogden, 9 Wheat. 1, 203; Railroad Company v. Husen, 95 U. S. 465, 470; Beer Company v. Massachusetts, 97. U. S. 25; New Orleans Gas Co. v. Louisiana Light Co., 115 U. S. 650, 661; Lawton v. Steele, 152 U. S. 133. It is equally true that the State may invest local bodies called into existence 'for purposes of local administration with authority in some appropriate way ,to safeguard the public health and the public safety. The mode or manner in which those results are to be accomplished is within the discretion of the State, subject, of course, so far as Federal power is concerned, only to the condition that no rule prescribed by a State, nor any regulation adopted by a local governmental - agency acting under the sanction of state legislation, shall contravene the Constitution-of the United States or infringe any right granted or secured by that- instrument. A local enactment or regulation, even if based on the acknowledged police powers of a State, must always yield in case of conflict with the exercise by the General Government of any power it possesses under the Constitution, or with any right which that instrument gives or secures. Gibbons v. Ogdon, 9 Wheat. 1, 210; Sinnot v. Davenport, 22 How. 227, 243; Missouri, Kansas & Texas Ry. Co. v. Haber, 169 U. S. 613, 626.

We come, then, to inquire whether any right given, or secured by the Constitution,' is invaded :by the statute as in*26terpreted by the state court. The defendant insists that his liberty is invaded when the State subjects him to fine or imprisonment for neglecting or refusing to submit to vaccination; that a compulsory vaccination law is unreasonable, arbitrary and oppressive, and, therefore, hostile to the inherent right of every freeman to care for his own body and health in such way as to him seems best; and that the'execution of such a law against one who objects to vaccination, no matter'for what reason, is nothing short of an assault upon his person. But the liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. On any other basis organized society could not exist with safety to its members. Society based on the rule that each one is a law unto himself would soon' be confronted with disorder and anarchy. Beal liberty .for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others. This court has more than once recognized it as a fundamental principle that “persons and property are subjected to all kinds of restraints and burdens, in order to secure the general comfort, health, and prosperity of the State; of the perfect right of the legislature to do which no question ever was, or upon acknowledged general principles ever can be made, so far as natural persons are concerned.” Railroad Co. v. Husen, 95 U. S. 465, 471; Missouri, Kansas & Texas Ry. Co. v. Haber, 169 U. S. 613, 628, 629; Thorpe v. Rutland & Burlington R. R., 27 Vermont, 140, 148. In Crowley v Christensen, 137 U. S. 86, 89, we.^aid: “The possession and •enjoyment of all rights are subject to such reasonable conditions as may be deemed by the governing authority of the country essential to the safety, health, peace, good order and morals of the community. Even liberty *27itself, the greatest of all rights, is not unrestricted license to act according to one’s own will. It is only freedom from restraint under conditions essential to the equal enjoyment of the same right by others. It is then liberty regulated by law.” . In the constitution of Massachusetts adopted in 1780 it was laid down as a fundamental principle of the social compact that the whole people covenants with each citizen, and each citizen with the whole' people, that all shall be governed by certain. laws for "the common good,” and that government is instituted "for the common good, for the protection, safety, prosperity and happiness of the people, and not for the profit, honor or private interests of any one man, family or class of men.” The good'and welfare of'the Commonwealth, of which the legislature is primarily the judge, is the basis on which the police power rests iii Massachusetts. Commonwealth v. Alger, 7 Cush. 53, 84.

Applying these principles to the present case; it is to be obserVed that the legislature of Massachusetts required the inhabitants of a city or town to be vaccinated only when, in the opinion of the Board of Health, that was necessary for the public health or the public safety. The authority to determine for all what ought to be done in such an emergency must have been lodged somewhere or in some body; and surely it was appropriate for the legislature to refer that question, in the first instance, to a Board of Health, composed of persons residing in the locality affected and appointed, presumably, because of their fitness to determine such questions. To invest such a body with authority over such matters was not an unusual nor an unreasonable or arbitrary requirement. Upon the principle of self-defense, of paramount necessity, a community has the right to protect itself against an epidemic of disease which threatens the safety of its members. It is to be observed that whén the regulation in question was adopted, smallpox, according to the recitals in the regulation adopted by the Board of Health, was prevalent to some extent in the city of Cambridge and the disease was increasing. If such was *28the situation — and nothing is asserted or appears in the record to the contrary — if we are to attach any value whatever to the knowledge which, it is safe to affirm, is common to all civilized peoples touching smallpox and the methods most usually employed to eradicate that disease, it cannot be adjudged that the present regulation of the Board of Health was not necessary in order to protect the public health and secure the public safety. Smallpox being prevalent and increasing' at Cambridge, the court would usurp the functions of another branch of government if it adjudged, as matter of law, that the mode adopted under the sanction of the State, to protect the people at large,, was arbitrary and not justified by the necessities of the case. We say necessities of the case, because it might be that an acknowledged power of a local community to protéct itself against an .epidemic threatening the safety of all, might be exercised in particular circumstances and in reference to particular persons in such an arbitrary, unreasonable manner, or might go so far beyond what was reasonably required for .the safety of the public, ás to authorize or compel the courts to interfere for the protection of such persons. Wisconsin &c. R. R. Co. v. Jacobson, 179 U. S. 287, 301; 1 Dillon Mun. Corp., 4th ed.,§§ 319 to 325, and authorities in notes; Freund’s Police Power, § 63 et seq. In Railroad Company v. Husen, 95 U. S. 465, 471-473, this court recognized the right of a State to pass sanitary laws, laws for the protection of life, liberty, health or property within its limits, laws to prevent persons and animals suffering under contagious or infectious diseases, or convicts, from coming within its borders. But as the laws ■there involved went beyond the necessity of the case and under the guise of exerting a police power invaded the domain of Federal authority and violated rights secured by the Constitution, this court deemed it to be its duty to hold such laws invalid. If the mode adopted by the .Commonwealth of Massachusetts for the protection of its local communities against smallpox proved to be distressing, inconvenient or objectionable to some — if nothing more could be reasonably *29affirmed of the statute in question — the answer is that it was the duty of the constituted authorities primarily to keep in view the welfare, comfort and safety of the many, and not per-v. mit the interests of the' many to be subordinated to the wishes . or convenience of the few. There is, of course, a sphere within which the individual may assert the supremacy of his own will and rightfully dispute the authority of any human government, especially of any free government existing under a written constitution, to interfere with the exercise of that will. But it is equally true that in every well-ordered society charged with the duty of conserving the safety of its members the rights of the individual in respect of his liberty may at times, under the. pressure of great ■ dangers, be subjected to such restraint, to be enforced by reasonable regulations, as-the safety of the general public may demand. An American citizen, arriving at an American port on a vessel in which, during , the voyage, there ha,d been, cases of yellow fever or Asiatic choléra, although apparently free from disease himself, may yet, in some circumstances, be held in quarantine against his will on board of such vessel or in a quarantine' station, until it be ascertained by inspection, conducted with due diligence, that the danger of the spread of the disease among the community at large has disappeared. The liberty secured by the Fourteenth Amendment, this court has said, consists, in part, in. the right of a .person “to. live and work where he will,” Allgeyer v. Louisiana, 165 U. S. 578, and yet he may be compelled, by force if need be, against his will and without regard to his personal wishes or-his pecuniary interests, or even his religious or political convictions, to take his place in the ranks of the army of his country and risk the chance of being shot down in its defense. It is not, therefore, true that the power of the public to guard itself against imminent danger depends in every case involving the control of one’s body upon his willingness to submit to reasonable regulations established by the constituted authorities, under the *30sanction of. the State, for the purpose of protecting the public collectively against such danger.

It is said, however, that the statute, as interpreted by the state court, although making an exception in favor of children certified by a registered physician to be unfit subjects for vaccination, makes no exception in the case of adults in like condition. But this cannot be deemed a denial of the equal protection of the laws to adults; for the statute is applicable equally to all in like condition and there are obviously reasons why regulations may be appropriate for adults which could not be safely applied to persons of tender years.

Looking at the propositions embodied in the defendant’s rejected offers of proof it is clear that they are more formidable by' their number than by their inherent value. Those offers in the main seem to have had.no purpose except to state the general theory of those of the medical profession who attach little or no value to vaccination as- a means of preventing the spread of smallpox'or who think that vaccination causes other diseases of the body. What everybody knows the court must know, and therefore the state court judicially knew, as this court knows, that an opposite theory accords with the common belief and is maintained by high medical authority. We must assumé' that when the statute in question was passed, the legislature of Massachusetts was not unaware of these opposing theories, and was compelled, of necessity, to choose be-, tween .them. It was not compelled to commit a matter involving the public health and safety to the final decision of a court or jury. . It is no part of the function of a court or a jury to determine which one of two modes was likely to be the most effective for the protection of the public against disease. That was for the legislative department to determine in the light of all the information it had or could obtain. It could not properly abdicate its function to guard the public health and safety. The state legislature proceeded upon the theory which recognized vaccination as at least an effective if not the best known way in which to meet and suppress the *31evils of a smallpox epidemic that imperilled an'entire population. Upon what sound principles as to the relations existing between the different departments of government can the court review this action of the legislature? If there is any such power in the judiciary to review legislative action in respect of a matter affecting the general welfare, it can only be whén that which the legislature has,done comes within the rule that if a statute purporting to have been enacted to protect the public •. health, the public morals or the public safety, has no real or substantial relation to those objects, or is, beyond all question, a plain, palpable invasion of rights secured by- the fundamental law, it is the duty of the courts .to so adjudge, and thereby give effect to the Constitution.” Mugler v. Kansas, 123 U. S. 623, 661; Minnesota v. Barber, 136 U. S. 313, 320; Atkin v. Kansas, 191 U. S. 207, 223.

Whatever may be thought of the expediency of this statute, it cannot be affirmed to.be, beyond question, in palpable conflict with the Constitution. . Nor, in view of the methods employed to stamp out the disease of smallpox, can anyone confidently assert that the means prescribed by the State to that end has no real or substantial relation' to the protection of the public health and the public safety. Such an assertion would not be consistent with the experience of this and other countries’ whose authorities have dealt with the disease of smallpox.1 And the principle of vaccination as a means to *32prevent the spread of smallpQx has been enforced in many States by statutes making the vaccination of children a condition of their right to enter or remain in public schools. Blue v. Beach, 155 Indiana, 121; Morris v. City of Columbus, 102 *33Georgia, 792; State v. Hay, 126 N. Car. 999; Abeel v. Clark, 84 California, 226; Bissell v. Davidson, 65 Connecticut, 183; Hazen v. Strong, 2 Vermont, 427; Duffield v. Williamsport School District, 162 Pa. St. 476.

*34The latest case upon the subject of which we are aware is Viemeister v. White, President &c., decided very recently by the Court of Appeals of New York, and the opinion in which has not yet appeared in the regular reports. That case involved the validity of a statute excluding from the public schools all children who had not been vaccinated. One contention was that the statute and ,the regulation adopted in exercise of its provisions was inconsistent with the rights, privileges and liberties of the citizen. The contention was overruled, the court saying,.among other things: “Smallpox is known of all to be a dangerous and contagious disease. If vaccination strongly tends to prevent the transmission or spread of this disease, it logically follows that children may be refused admission to the public schools' until they have, been vaccinated. The appellant claims that vaccination does not tend to prevent smallpox, but tends to bring about other diseases, and that it does much harm, with nó good.

“ It must be-conceded that spme laymen, both learned and unlearned, and some physicians of great skill and repute, do not believe that vaccination is a preventive of smallpox. The common belief, however, is that it has a decided’ tendency to prevent the spread of this fearful disease and to render it less dangerous to those who contract it. While not accepted by all, it is accepted by the mass of the people, as well as by most members of the medical profession. It has been- general in our State and in most civilized nations for generations. It is *35generally accepted in theory and generally applied in practice, both by the voluntary action of the people and in obedience to the command of law. Nearly every State of the Union has statutes to encourage, or directly .or indirectly to require, vaccination, and this is true of most nations of Europe. ■. . .

. “ A common belief, like, common knowledge, does not require evidence to establish its existence, but may be acted upon without proof by the legislature and the courts. . . .

“ The fact that the belief is not universal is not controlling, for there- is scarcely -any helief that is accepted by everyone. The possibility that the belief may be wrong, and that science may yet show it to be wrong, is not conclusive; for the legislature has the right to pass laws which;- according to the common belief of the people, are adapted to prevent the spread of contagious diseases. In a free country, where the government is by the people, through their chosen representatives, practical legislation admits of no other standard of action; for what the. people believe, is for the common welfare must be accepted as tending to promote the common welfare, whether it does in fact or not.. Any other basis would conflict with the spirit of the Constitution, and would sanction measures opposed to a republican form of government. While we do not decide and cannot decide that vaccination is a preventive of smallpox, we take judicial notice of the fact .that this is the common belief of the people of the State, aind with this fact as a foundation we hold that the statute in question is a health law, enacted in a reasonable and proper exercise of the police power.”- 72 N. E. Rep. 97.

Since then vaccination, as a means of protecting a community against smallpox, finds strong support in the experience of this and other countries, no court, much less a jury, is justified in disregarding the action of the legislature simply because in -its or their opinion that particular method was— perhaps or possibly — noUthe best either for children or adults.

Did the. offers of proof made by the defendant present a case which; entitled him, while remaining in Cambridge, to *36claim exemption from the operation of the statute and of the regulation adopted by the Board of Health? We have already said that his rejected offers, in the main, only set forth the theory of those who had no faith in vaccination as a means of preventing the spread of smallpox, or who thought that vaccination, without benefiting the public, put in peril the health of the person vaccinated. But there were some offers which it is contended embodied distinct facts that might properly have been considered. Let us see how this is.

The defendant offered to prove that vaccination “quite often” caused serious and'permanent injury to the health of the person vaccinated; that the operation “occasionally” resulted in death; that it was “impossible” to tell “in any particular case” what the results of vaccination would be or whether it yould injure the health- or result in death; that “quite often” one’s blood is in a certain condition of impurity when it is not prudent or, safe to vaccinate him; that there is no practical test by which to determine “with any degree of certainty” whether one’s blood is in such condition of impurity as to render vaccination necessarily unsafe or dangerous; that vaccine matter is “quite often” impure and dangerous to -be used, but whether impure or not cannot be ascertained by any known practical test; that the defendant refused to submit to vaccination for the reason that he had, “when a child,” been caused great and extreme suffering for a long period by a disease produced by vaccination; and that' he had witnessed a similar result of vaccination not only in the case of his son, but in the cases of others.'

These offers, in effect, invited -the court and jury to go over-the whole ground gone over by the legislature when it enacted the statute in question. The legislature assumed that some children, , by reason of their condition at the- time, might not be fit subjects of vaccination; and it is suggested — and we will not say without reason — that such is the case with some adults. But the defendant did not offer to prove that, by reason of his then condition, he was in fact not a fit subject of-vaccination *37at the time he was informed of the requirement of the regulation adopted by the Board of Health. It is entirely consistent with his offer of proof that, after reaching full age he had become, so far as medical skill could. discover, and when informed of the regulation of the Board of Health was, a fit subject of vaccination, and that, the vaccine matter to be used in his case was such as any medical practitioner of good standing would regard as proper to be used. The matured opinions of medical men-everywhere, and the experience of mankind, as all must know, negative the suggestion that it is not possible in any case to determine whether vaccination is safe. Was defendant exempted from the operation of the statute simply because* of his dread of the same evil results experienced by him when .a child and had observed in the cases of his son and other children? Could he reasonably claim such an exemption because “quite often” or “occasionally” injury had resulted from vaccination, or because it was impossible, in the opinion of some, by any practical test, to determine with absolute certainty-whether a particular person could be safely vaccinated?

It seems to the court that an affirmative answer to these questions would practically -strip the legislative department of its function to care for the public health and the public safety when endangered by epidemics of disease. Such an answer would mean that compulsory vaccination could not, ■in- any conceivable case, be legally enforced in a community, even at the command of the legislature, however widespread the epidemic of smallpox, and however deep and universal was the belief of the community and of. its medical advisers, that a system of general vaccination was vital to the safety of all.

We are not prepared to hold that a minority, residing or •remaining in any city or town where smallpox is prevalent, and enjoying the general protection afforded by'an organized local government, may thus defy the will of its constituted authorities, acting in good faith for all, under the legislative sanction of. the State. If such be the privilege of a minority

*38then a. like privilege would belong to each individual of the community, and the spectacle would be presented of the welfare and safety of- an entire population being subordinated to the notions of a single individual who chooses to remain a part of that population. We are unwilling to hold it to be. an element in the liberty secured by the Constitution of the United States that one person, or a minority of persons, residing in any community and enjoying the -benefits of its local government, should have the power thus to dominate the majority when supported in their action by the authority of the State. While this court should guard with firmness every right appertaining to life, liberty or property as secured to the individual by the Supreme Law of the Land, it is of the last importance that it should not invade the domain of local' authority' except when it is plainly necessary to do so in order to enforce that law. The safety and the health of the people of Massachusetts are, in the -first instance, for that Commonwealth to guard and protect. They are matters that do not ordinarily concern the National Government. So far as they can be reached by any government, they depend, primarily, upon such action as the State in its wisdom may take; and we do not perceive that this legislation has invaded any right secured by the Federal Constitution.

Before closing this opinion we deem it appropriate, in order to prevent misapprehension, as to our views, to observe— perhaps to repeat a thought already sufficiently expressed, namely — that the police power of a State, whether exercised by the legislature, or by a local body acting under its authority, may be exerted in such circumstances or by regulations so arbitrary and oppressive in particular cases as to justify the interference of the courts to prevent wrong and oppression. Extreme cases can be readily suggested. Ordinarily such cases are -not safe guides in the administration of the law. It is easy; for instance, to suppose the case of an adult who is embraced by the mere words of the act, but yet to subject whom to vaccination in a particular condition of his health *39or body, would be cruel and inhuman in the last degree. We are not to be understood' as holding that the statute ^was intended to be applied to such a case, or, if it was so intended, • that the judiciary would not be competent to interfere and protect the health and life of the individual concerned. “All laws,” this court has said, “should receive'a sensible construction. General terms should be so limited in their application as not to lead to injustice, oppression or absurd consequence! It will always, therefore, be presumed that the legislature intended exceptions to its language which would avoid results of that character. The reason of the law in such cases should prevail over its letter.” United States v. Kirby, 7 Wall. 482;. Lau Ow Bew v. United States, 144 U. S. 47, 58. Until otherwise informed by the highest court of Massachusetts we are not inclined to hold that the statute establishes the absolute rule that an adult must be vaccinated if it be apparent or can be shown with reasonable certainty that he is not' at the time a fit subject of vaccination or that vaccination, by reason of his then condition, would seriously impair his health or probably cause his death. No such case is here presented. It is the case of an adult who, for aught that appears, was himself in perfect health-and a fit subject of vaccination, and yet,' while remaining in the community, refused to obey the statute and' the regulation adopted in execution of its provisions -for the protection of the public- health and the pubjic safety, confessedly endangered by the presence of a dangerous disease.

. We now decide only that the statute covers the present case, • and that nothing clearly appears that would justify this court in holding it to be unconstitutional and inoperative in its application to the. plaintiff in error.

The judgment of the court below must be affirmed.

It is 'so ordered.

Mr. Justice Brewer and Mr. Justice Peckham dissent.'

7.3 Buck v. Bell 7.3 Buck v. Bell

BUCK v. BELL, SUPERINTENDENT.

No. 292.

Argued April 22, 1927.

Decided May 2, 1927.

*201Mr. I. P. Whitehead for plaintiff in error.

*203Mr. Aubrey E. Strode for defendant in error.

*205Mr. Justice Holmes

delivered the opinion of the Court.

This is a writ of error to review a judgment of the Supreme Court of Appeals of the State of Virginia, affirming a judgment of the Circuit Court of Amherst County, by which the defendant in error, the superintendent of the State Colony for Epileptics and Feeble Minded, was ordered to perform the operation of salpingectomy upon Carrie Buck, the plaintiff in error, for the purpose of making her sterile. 143 Va. 310. The case comes here upon the contention that the statute authorizing the judgment is void under the Fourteenth Amendment as denying to the plaintiff in error due process of law and the equal protection of the laws.

Carrie Buck is a feeble minded white woman who was committed to the State Colony above mentioned in due form. She is the daughter of a feeble minded mother in the same institution, and the mother of an illegitimate feeble minded child. She was eighteen years old at the time of the trial of her case in the Circuit Court, in the latter part of 1924. An Act of Virginia, approved March 20, 1924, recites that the health of the patient and the welfare of society may be promoted in certain cases by the sterilization of mental defectives, under careful safeguard, &c.; that the sterilization may be effected in males by vasectomy and in females by salpingectomy, without serious pain or substantial danger to life; that the Commonwealth is supporting in various institutions many defective persons who if now discharged would become *206a menace but if incapable of procreating, might be discharged with safety and become self-supporting with benefit to themselves and to society;.and that experience has shown that heredity plays an important part, in the transmission of insanity, imbecility, &c. The statute then enacts that whenever the superintendent of certain institutions including the above named State Colony shall be of opinion that it is for the best interests of the patients and of society that an inmate under his care should be sexually sterilized, he may have the operation performed upon any patient afflicted with hereditary forms of insanity, imbecility, &c., on complying with the very careful provisions by which the act protects the patients from possible abuse.

The superintendent first presents a petition to the special board of directors of his hospital or colony, stating the facts and the grounds for his opinion, verified by affidavit. Notice of the petition and of the time and place of the hearing in the institution is to be served upon the inmate, and also upon his guardian, and if there is no guardian the superintendent is to apply to the Circuit Court of the County to appoint one. If the inmate is a minor notice also is to be given to his parents if any with a copy of the petition. The board is to see to it that the inmate may attend the hearings if desired by him or his guardian. The evidence is all to be reduced to writing, and after the board has made its order for or against the operation, the superintendent, or the inmate, or his guardian, may appeal to the Circuit Court of the County. The Circuit Court may consider the record of the board and the evidence before it and such other admissible evidence as may be offered, and may affirm, revise, or reverse the order of the board and enter such order as it deems just. Finally any party may apply to.the Supreme Court of Appeals, which, if it grants the appeal, is to hear the case upon the record of the trial *207in the Circuit Court and may enter such order as it thinks the Circuit Court should have entered. There can be no doubt that so far as procedure is concerned the rights of the patient are most carefully considered, and as every step in this case was taken in scrupulous compliance with the statute and after months of observation, there is no doubt that in that respect the plaintiff in error has had due process of law.

The attack is not upon the procedure but upon the substantive law. It seems to be contended that in no circumstances could such an order be justified. It certainly is contended that the order cannot be justified upon the existing grounds. The judgment finds the facts that have been recited and that Carrie Buck “ is the probable potential parent of socially inadequate offspring, likewise afflicted, that she may be sexually sterilized without detriment to her general health and that her welfare and that of society will be promoted by her sterilization,” and thereupon makes the order. In view of the general declarations of the legislature and the specific findings of the Court, obviously we cannot say as matter of law that the grounds do not exist, and if they exist they justify the result. We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Jacobson v. Massachusetts, 197 U. S. 11. Three generations of imbeciles are enough.

*208But, it is said, however it might be if this reasoning were applied generally, it fails when it is confined to the small number who are in the institutions named and is not applied to the multitudes outside. It is the usual last resort of constitutional arguments to point out shortcomings of this sort. But the answer is that the law does all that is needed when it does all that it can, indicates a policy, applies it to all within the lines, and seeks to bring within the lines all similarly situated so far and so fast as its means allow. Of course so far as the operations enable those who otherwise must be kept confined to be returned to the world, and thus open the asylum to others, the equality aimed at will be more nearly reached.

Judgment affirmed.

Mr. Justice Butler dissents.