Pox

by Michael Willrich

  Still, negative advertising was a risky marketing strategy: the American public did not need much encouragement to think that vaccines were vile and dangerous.

  The American newspapers followed the Camden vaccine investigation like a criminal trial. The story certainly had the elements of a good police procedural: dead schoolchildren, intimations of a corporate cover-up, and men in laboratory coats keeping a sober vigil over culture dishes and white rats.

  To lead its investigation, the Camden Board of Health secured the services of a young Philadelphia physician named Albert C. Barnes. A brilliant and eccentric man who never shrank from a fight, Barnes grew up in the hardscrabble section of South Philadelphia known as “The Neck.” Educated at Philadelphia’s renowned Central High, he paid his way through the University of Pennsylvania Medical School by boxing and playing semiprofessional baseball. An M.D. at twenty, he studied chemistry at the University of Berlin (and later at Heidelberg). Returning to Philadelphia in 1896, Barnes began working as a consulting chemist for Mulford Company and quickly rose to a full-time position as advertising and sales manager. Placing a Mulford man in charge of an investigation of Mulford products may seem scandalous today. But the move raised few eyebrows at a time when business, medicine, and public health authority often moved in unison. (Not long after the Camden episode, Barnes began amassing his own pharmaceutical fortune by inventing, with a German colleague, the antiseptic Argyrol; he spent that fortune building one of the great private collections of modern French art, the Barnes Foundation in Merion, Pennsylvania.)56

  Barnes’s unique combination of talents made him an able defender of the Camden Board of Health and Mulford. The doctor traveled to New York to keep the city’s leading papers and their wire services apprised of the ongoing investigation. Barnes pressed the point that the same virus had been used on a million people living within thirty miles of Philadelphia, “and few, if any, fatal results were reported.” The Tribune praised the board’s man: “Dr. Barnes, the expert employed by the authorities of Camden to look into this trouble, throws a flood of light on its origin.” Papers that a few days earlier had impugned Mulford vaccine now lingered over local factors: Camden’s dry weather, dusty streets, filthy children, and negligent parents. As Barnes told his audience, the fatal cases had occurred “among the lower class of people, who by their own carelessness poisoned the wounds with tetanus, or lockjaw, bacteria.” The vaccine and the physicians who used it were “perfectly blameless.” The Sun, one of the first newspapers to implicate Mulford, now told its readers that tetanus was simply “in the air,” just waiting for “any cut or scratch . . . to give it a lodging place.” It was “highly unfortunate,” the paper added, “that a period of prevalence of tetanus germs should have coincided with a period of vaccination.” The chemist cum adman had sold the press the oldest story in the annals of public health: the poor begot filth, and filth begot disease.57

  The Camden Board of Health finally released its full report, on November 29, 1901. By then all of the major findings had already been delivered by Barnes to the New York papers. The terse report combined bacteriology and epidemiology with an older emphasis on atmospheric and environmental factors. The board had tracked down samples of the various makes of vaccine used in the city and sent them to the New Jersey state bacteriologist. Laboratory tests failed to detect tetanus in the samples. Meanwhile, physicians at Camden’s Cooper Hospital had used vaccine purchased from fifteen separate Camden pharmacies to inoculate white rats, known to be highly susceptible to tetanus. Not one developed the disease. Epidemiological evidence supported the laboratory data. According to standard medical treatises, acute tetanus occurred within five to nine days after the introduction of bacilli in the body. But the Camden children had not fallen ill for about three weeks after vaccination. All of this constituted “indisputable evidence,” in the words of the report, “that the tetanus germs were not introduced at the time of vaccination.” Following Henry Davis’s original suggestion, the report attributed the tetanus outbreak to the peculiar “atmospheric and telluric conditions” (the dry, dusty weather) that had prevailed in Camden that fall. To demonstrate that the germs were present “in the atmosphere,” the board cited the case of a boy who got tetanus from a gunshot wound that fall. Other germs had made their way onto the vaccine wounds of a few luckless children who had left their wounds uncovered, wrapped them in filthy rags, or, worse, “scratched the vaccinated area with their dirty fingers and nails and infected the wound.” At the conclusion of the report, the board expressed its “unanimous opinion” that compulsory vaccination should resume in Camden.58

  Medical science and public relations know-how had come to the defense of the vaccine industry at its hour of greatest need. The American Druggist and Pharmaceutical Record, an industry trade journal, expressed relief. The Record urged “every intelligent person” to “do all that is possible to prevent the spread of unnecessary and ill-founded alarm from the accidental occurrence of tetanus following, but in no wise due to vaccination.”59

  And yet there were doubts. The board’s “vigorous ex parte denial,” as a New York Times editorial skeptically referred to the report, did not silence the public narrative that tied the suffering of little children to tainted commercial vaccine. The Philadelphia North American agreed: “The prima facie evidence of connection between vaccination and tetanus is too strong to be refuted by mere assertion of opinion by the vaccinators.” Addressing the New York Academy of Medicine, W. R. Inge Dalton, a physician and professor, said he was not persuaded by the report. “In Camden the manufacturer and the medical men have co-operated in exonerating themselves, and have thrown all the blame on the parents of the children,” Dalton said. If tetanus bacilli were simply “in the air,” it was remarkable that they had a “selective predilection for sores produced by particular kinds of vaccine virus.”60

  In Philadelphia, a scientific debate on the merits of the board’s argument had begun even before the report’s release. Addressing the Philadelphia Medical Society on November 27, Dr. Robert N. Willson presented a paper about a case he had recently handled. An eleven-month-old child had died of tetanus following vaccination. Willson concluded that the child’s father, a coachman, had carried the tetanus from the stable to the nursery. Insisting there had never been any connection between vaccine and tetanus, Willson told his audience that the only cure for “rampant” opposition to vaccination was a “new scrupulousness” toward the vaccination wound. No doubt many of his listeners applauded. But at least one remained unconvinced. Dr. Joseph McFarland, the man who had built Mulford’s antitoxin laboratory, took the floor. He had been following the tetanus cases closely, he said, and was conducting his own study of the subject. He had learned enough already to suspect that Willson’s “extremely optimistic view . . . concerning the harmlessness of vaccine virus might not be correct.” Five months later, the two physicians would meet again in that same room to debate the issue.61

  Nor had the board’s investigation stopped the pain and death in Camden. On the night of November 25, thirteen-year-old Ada Heath died of lockjaw. Her parents had paid a local druggist twenty-five cents to vaccinate her. On November 26 came the death of nine-year-old Georgiana Overby, the first African American child among the afflicted, and the first of the tetanus victims to have received her vaccination in the free dispensary. “[S]he, too, died in agony,” the Tribune reported. From nearby Jordantown came the news that four-year-old Flora Johnson, also African American, had died, “apparently suffering from tetanus, following vaccination.” The final Camden case was reported on December 4. Three days later Bessie Rosevelt, age seven, the daughter of a local horse dealer, died at her home on Ferry Avenue. No two of the new cases had been vaccinated by the same physician. The Tribune awkwardly noted that Bessie’s was the “fourteenth case since the epidemic [of tetanus] made its appearance, and despite the fact that it has been found that the disease does not come from vaccination lymph, all of the victims have been vaccin
ated.” A headline in the Omaha World-Herald suggested that for much of the public, the story was more straightforward: “Poisoned Vaccine Still Proving Fatal at Camden, N.J.”62

  If the mere assertion of expert opinion could not restore public confidence in vaccine, at the height of the most extensive U.S. epidemic of small-pox in recent memory, then what could? The Times warned that this was “not a momentary sensation.” St. Louis and Camden had done “incalculable injury” to medical progress, while the profession whose “pride and business interest” were most closely tied to that cause stood idly by. In the coming months, the American medical profession would be anything but idle. The New York County Medical Society resolved to investigate the “entire subject” and to determine “the steps that should be taken to guard against the possibility of a repetition of such deplorable disasters.” Other societies followed suit, as one local and state organization after another called for investigations of the vaccine industry and debated the need for government control. Physicians stepped away from both the biologics makers and the public health boards, seriously considered their own interests, and worked to restore public confidence in vaccination.63

  Physicians knew better than anyone that even under the best of circumstances vaccination carried health risks. The same late nineteenth-century developments in bacteriology that had made U.S. military medicine a much safer and more ambitious enterprise had introduced a heightened concern for aseptic practices in routine medical procedures, including vaccination. As Arthur Van Harlingen, a Philadelphia doctor, noted approvingly in 1902, “few men will now come to the delicate infant with the odor of stable and animal on the unwashed hands, or will moisten their instruments with their own saliva.” And still physicians knew that introducing animal vaccine into the human system could produce unpredictable results, especially if the patient did not have the constitution for it, or if the vaccine itself was impure.64

  American doctors had been concerned about vaccine quality since the first wave of the turn-of-the-century smallpox epidemics spread across the southern states in 1898 and 1899. But the doctors had kept their worries mostly to themselves, maintaining a solid (if occasionally splintery) defense of vaccine before the public. Their own medical society minutes and journals told a different story. Physicians and health officials—including a few federal officials such as C. P. Wertenbaker of the U.S. Marine-Hospital Service—complained that contaminated tubes and points were producing sore arms and open rebellions. At a meeting of the North Carolina Medical Society, local physicians swapped stories about “the violent results” caused by the vaccines they were receiving from northern manufacturers. “The popular prejudice against vaccination is not wholly without justification,” one doctor confessed. He recalled many “very sore arms” and lamented the suffering of his “own little daughter [who] was for three days violently ill” after he vaccinated her. As the epidemics spread north, the stories were much the same. From Omaha, Dr. F. T. Campbell wrote of the “vile vaccine” found on the shelves of grocery stores. “[A]nd so the ‘sores’ ran wild with contiguous and constitutional infection. From such cases came complaints that vaccination was ‘worse than smallpox.’” By the time tetanus broke out in Camden, American physicians had good reason to wonder what was really in those skinny tubes and points they carried around in their pockets.65

  At the Marine-Hospital Service’s Hygienic Laboratory in Washington, Milton Joseph Rosenau was wondering the same thing. In the winter of 1901–2, he determined to find out, secretly buying up samples from eight different vaccine makers on the open market and taking them back to his laboratory. The thirty-three-year-old scientist knew Philadelphia and its environs well: a native of the city, like Albert Barnes and Joseph McFarland, he had received his education in its public schools and at the University of Pennsylvania. After completing his medical training in 1889, Rosenau joined the Marine-Hospital Service, serving as a quarantine officer in San Francisco and, at the close of the Spanish-American War, in Santiago. After a decade in the field, he took over the Hygienic Laboratory, which he transformed from a one-man outfit into a leading government scientific institution. A brilliant scientist with the heart of a reformer, Rosenau’s scientific interests ranged across bacteriology, chemistry, and pharmacology. As early as April 1900, Wertenbaker had focused Rosenau’s attention on the problem of vaccine purity by sending him some points and lymph for testing. A few teeming cultures and one dead mouse later, Rosenau confirmed Wertenbaker’s suspicion that the dry points on sale in the South crawled with pathogens. In a private letter, Surgeon General Wyman had cautioned Wertenbaker against reading too much into Rosenau’s report. “The work confirms the well known fact that glycerinized lymph is superior to dry points and no other conclusion should be drawn from the report,” Wyman advised.66

  A broader conclusion was inescapable after Rosenau tested the vaccine samples he collected on the open market, at the height of the national vaccine crisis, in the winter of 1901–2. The federal scientist presented his preliminary findings to the New York Academy of Medicine in February 1902. Like Walter Reed before him, Rosenau found a great unevenness in the quality of vaccine on the market. On average, each nonglycerinated dry point Rosenau examined had 4,809 bacterial colonies, while the glycerinated lymph averaged 2,865 colonies per sample. (The journal Pediatrics recoiled at this “ridiculous amount of impurity.”) The contaminants included staphylococci, pus cocci, and an assortment of molds common to the hay and dust of the stable. What made Rosenau’s report news was his argument that vaccine makers placed too much confidence in the germicidal powers of glycerin. The makers had “become careless of contamination, trusting to the glycerin to purify their product.” And in their haste to meet the high demand for vaccine during the national wave of smallpox epidemics, makers had not given the glycerin sufficient time to work, flooding the market with “green” virus.67

  Rosenau did not shy away from the political implications of his data. He told Wyman, “Our results so far have plainly indicated that the manufacture of vaccines is too important a subject to leave to commercial enterprise without restrictions.” Many in the medical profession agreed. As the Medical News observed, “The enforcement of government inspection with power to prevent the sale of improper material seems to be the desideratum.”68

  Rosenau’s paper accomplished what only a federal report could do. Coming so fast on the heels of St. Louis and Camden, it persuaded American doctors and public health officials, working in local communities across the United States, that defective vaccine was a national problem that required a national solution. Many had seen the hideous effects of bad vaccine in their own patients, and their consciences troubled them. “The inoculation of such vaccine is followed by severe reaction, including fever, erysipelatous dermatitis, a deep, sloughing sore, and great swelling of the arm,” the Cleveland Journal of Medicine reported. And after all of that, some vaccine still produced “no immunity to subsequent smallpox.” The Sanitarian , a leading voice of the public health profession, lamented “the poisonous character of much of the vaccine that is put upon the market at the present day.” Nine tenths of that vaccine might be fine, but there was “no telling how much harm may be done by the remaining one-tenth . . . or how many anti-vaccinationists it may produce.” “Something will have to be done,” the Sanitarian concluded, “to rehabilitate vaccine virus in the estimation of the medical profession as well as of the general public.”69

  The old rhetoric of the vaccination argument had lost its persuasive powers, even for some of the measure’s strongest supporters. Cost-benefit arguments were not enough. Vaccination was a political measure, ordered for the most benevolent of purposes. But vaccine was a commercial product, and like all such wares, its success depended upon the confidence of consumers. Public confidence in the market—and thus in the measure—had collapsed. Vaccination itself was, as one New York physician observed, “at a crisis.” And that crisis exposed to all the fundamental contradiction characterizing the p
rocedure: the government compelled vaccination, but it would not vouch for vaccine.70

  Dr. Theobald Smith, a scientist with the Massachusetts Board of Health, was one of the growing number of officials and physicians who demanded reform in 1902. “Without the specific protection given by vaccination, small-pox cannot be efficiently controlled and suppressed,” Smith said. “The acceptance of this proposition by the medical profession and the State creates the responsibility of supplying as pure and efficient vaccine virus as can be made under present conditions.”71