An early adopter of vaccination was a paragon of the Age of Enlightenment, Napoleon Bonaparte.40 Ever a consummate strategic thinker, Bonaparte realized that expansion beyond France’s historical borders necessarily involved intimate contact with an ever-increasing number of people and that war tended to increase the breadth and severity of infectious diseases. Thus, the emperor ordered that his troops be vaccinated for smallpox in order to provide a strategic advantage over adversaries who were less progressive-minded.
Napoleon retained an extraordinary fondness for Edward Jenner, who was allowed to travel at will in Europe. This amity flew in the face of the Continental System, which otherwise forbade all British commerce or travel. Likewise, Napoleon allowed Jenner to repatriate prominent British citizens who were isolated on the Continent in 1803 after a resumption in hostilities that concluded a yearlong peace as negotiated in the Treaty of Amiens. Once hostilities resumed, many prominent British citizens were trapped in Napoleonic Europe, including the Earl of Yarmouth, members of Parliament, and prominent academics.41, 42 In requesting their liberation, Jenner wrote to compatriots at the National Institute of France: “Gentlemen, Pardon my obtruding myself on you at this juncture. The Sciences are never at War. Permit me, then as a public body with whom I am connected to solicit the exertion of your interest in the liberation of Lord Yarmouth.”43 Comparable communications succeeded in gaining the freedom of others, as evidenced by Napoleon’s statement, “Ah, Jenner, je ne puis rien refuser a Jenner” (Ah, Jenner, I can refuse him nothing).44 Ironically, and perhaps as a result of active repulsion against Napoleon and his dictatorship, the French army actively rejected smallpox vaccination in the years following Waterloo, a decision that would prove deadly to many thousands of French troops and contribute to their 1870 loss in the Franco-Prussian War. (The decision was made worse by the fact that Bismarck had compelled his troops to be vaccinated during the same campaign.)45
On the other side of the Atlantic, a once and future English adversary, the United States, was also quick to embrace vaccination, driven by another Enlightenment thinker. Thomas Jefferson advocated vaccination. While serving as president in 1806, he wrote to Jenner, “Medicine has never before produced any single improvement of such utility . . . You have erased from the calendar of human afflictions one of its greatest . . . Mankind can never forget that you have lived.”46 The manner by which Jefferson learned of Jenner’s achievement is worth relating, both to demonstrate the brilliance of the man and, consistent with other events that have created considerable ambiguity, actions that raise serious questions about his moral choices.
Benjamin Waterhouse was a key thought leader in the early United States. The native Rhode Islander trained at the Universities of Edinburgh and Leiden (where he received his medical degree in the spring of 1780). Waterhouse was a degreed physician, rather than a physician who obtained his qualifications by shadowing a practicing doctor.47 As such, his credentials were a relative rarity upon his return to the new United States in 1782 (which, despite the defeat of Lord Cornwallis at Yorktown the year before, was technically still at war). Unsurprisingly, Waterhouse was highly sought after and accepted a position as a founding faculty member of the new medical training program at Harvard University in September 1782. This made Harvard only the third medical school in the fledgling United States, after the founding of comparable institutions at Benjamin Franklin’s University of Pennsylvania (1765) and Columbia University (1767).
By the time of Waterhouse’s return, the United States had already gained a reputation as a progressive nation, at least in terms of smallpox prevention. In the first year of the Revolution, a disastrous attempt by the thirteen colonies to invade Quebec failed, largely as a result of a rampant smallpox outbreak that decimated General Richard Montgomery’s troops, causing a loss of life that was equaled by a crushing blow to morale on the eve of battle.48 Most of the British defenders, in contrast, had been variolated, lengthening the mismatch that inevitably capped Gates’s failure to capture Montreal. Learning from this outcome, Washington ordered all troops in the Continental Army to be variolated. This was a bold step, given the high death rate at the time; approximately 12 percent would succumb as a result of the procedure, even under ideal conditions, and the conditions in Washington’s camp were hardly optimal.
The country to which Waterhouse had returned was just taking shape, and the control of the federal government was still largely in limbo. Disarray reigned supreme as Waterhouse helped establish what would eventually evolve into the Harvard School of Medicine. Waterhouse, a native of Newport, Rhode Island, had close ties to Europe, having attended college at the University of Edinburgh and then training as a physician at Leiden University. Waterhouse proved a most capable physician and scientist and his career vaulted forward, eventually reaching the high honor of election to the American Academy of Arts and Sciences. His election to this nascent but extraordinary society was preceded by a handful of important Americans such as John Adams, his cousin Samuel, and John Hancock.49 To put this in perspective, the new academy elected a handful of new members per year, and Waterhouse’s class of 1795 came a year after the election of James Madison.
Through the years, Waterhouse kept abreast of the latest medical breakthroughs. Immediately upon learning of Jenner’s success, Waterhouse penned an article to the Columbian Sentinel, a Boston periodical, on March 12, 1799, extolling the virtues of this new procedure.50 In parallel, he reached out to John Haygarth, a prominent British physician specializing in smallpox, to request a sample inoculum to be tested in the United States.51 By July of the following year, the requested samples arrived, and Whitehouse immediately vaccinated his wife and children.52 Having a monopoly on the procedure (with the only samples and experience in conducting immunization in the Western Hemisphere), Waterhouse capitalized upon this fact. Drawing upon his prominence and many powerful connections throughout the young nation, Waterhouse functioned as the sole distributor of the new vaccine, requiring that the clinicians administering the vaccine share a fraction of their proceeds with Waterhouse.53
This entrepreneurial approach elicited a firestorm of media protest, which was enflamed further when Waterhouse, in the long summer months of 1800, petitioned his old housemate from his medical school days. That man happened to be John Adams, the sitting president of the United States.54, 55 While Adams had been ambassador to the Dutch Republic, Waterhouse had been conducting his medical training in Leiden and residing in Adams’s ambassadorial home. The two had established an enduring correspondence, which now allowed Waterhouse to urge Adams to advocate for Jenner’s new vaccination strategy, presumably for the public good but which would enrich Waterhouse personally. Adams, perhaps aware of the controversy, acknowledged receipt of Waterhouse’s request and forwarded it to the aforementioned American Academy of Arts and Sciences, which sat on it for the remainder of the second president’s term.56
Regardless of his reasons for tabling the smallpox vaccine, Adams was deeply engrossed in his own problems, which centered upon a contentious reelection campaign against his former best friend, newly sworn enemy, and sitting vice president, Thomas Jefferson. This would serve to be the first truly contested reelection in American history, embroiling the two in the most caustic and derisive election campaign in American history (even measured by today’s low standards), with accusations that Jefferson fathered a child with one of his slaves (accurate) and that Jefferson and Adams were pawns in the employ of the French and British governments, respectively (both inaccurate). As the mudslinging degenerated into a virtual civil war among Federalists in the Electoral College, the Democrat Jefferson prevailed after an equally contentious vote count that rang with recriminations of “defective electoral ballots” from the Georgia delegation (surprisingly reminiscent of the “hanging chads” controversy two hundred years later).
Hedging his bets, Waterhouse bided his time. Amidst the turmoil, he reached out to Jefferson at his Monticello home with a letter dated December 1,
1800, in which he appealed to the vice president’s patriotism to advocate for broad use of the smallpox vaccine in the United States.57 Waterhouse included in this letter a pamphlet (which may be viewed cynically as an advertisement) for Jefferson to ponder. As Jefferson read the pamphlet on December 24, he found himself more inclined towards action and replied enthusiastically on Christmas Day.
Jefferson connected Waterhouse to a network of physicians throughout Virginia and initiated experimentation at Monticello, as well as within the confines of the White House itself. In an act that would blanch even the most strident modern spin doctors, Jefferson oversaw the intentional infection of slaves with the most deadly disease known to man. The first “volunteer” was a slave by the name of Ursula Granger, the daughter of two of Jefferson’s Monticello slaves and a member of Jefferson’s kitchen staff at the Executive Mansion.58 Unfortunately, the May 29, 1801 experiment failed to elicit an immune response, but Jefferson was undeterred. Using fresh material, Jefferson successfully oversaw the immunization of two other slaves while at Monticello that summer, including that of his butler (Burwell Colbert) and blacksmith (Joseph Fossett).59 Unlike the experience at the White House months earlier, both men displayed the characteristic swelling and redness, suggesting the vaccine was effective. The exudates from Colbert and Fossett were harvested for use in additional experiments.60 Over the remainder of the summer, almost fifty Monticello slaves served as guinea pigs. As an even more audacious act, many of these slaves were subsequently challenged with native smallpox to ensure that the vaccine had indeed conferred protection (which, thankfully, it had). Based on these positive findings, Jefferson then proceeded to vaccinate two dozen of his own family members. By the early autumn of 1801, he began distributing smallpox vaccine throughout his native state of Virginia. Later that fall, the president personally advocated the expanded use of smallpox vaccine to other states, soliciting the support of other prominent physicians such as Dr. John Redman Coxe of Philadelphia and Dr. Edward Gantt of Washington. As a sign of friendship, Gantt vaccinated the chief of the Miami Indians, Little Turtle (or Mihšihkinaahkwa), during his 1802 visit to Washington.61
Within the United States, the popularity of smallpox vaccination expanded rapidly. By 1809, vaccination was mandatory in Massachusetts. School systems began to require children to be vaccinated for smallpox prior to enrollment; by the end of the century, the disease was largely restricted to the urban poor. Despite these encouraging outcomes, periodic outbreaks continued, with no fewer than eight epidemics recorded in Philadelphia between 1800 and 1850, with six in Boston and three in Baltimore. The situation was far worse for the native Amerindians, who (unlike Little Turtle) remained largely unvaccinated. Terrifying outbreaks in 1801–02 and 1836–40 exterminated entire tribes and depopulated much of the United States west of the Mississippi River. An outbreak in Brooklyn, New York, among the city’s homeless in 1893–94 sparked particular public outrage. Individuals trained to give vaccinations flourished as these “vaccinators” were rewarded with thirty cents for each person vaccinated (though this same lure also caused less scrupulous vaccinators to treat the same patients multiple times).62, 63
Despite high-powered backing for vaccines and massive outbreaks in 1865, 1871, and 1881, much of the American population still remained unvaccinated. While the army that faced the British in the War of 1812 was compelled to be vaccinated against smallpox, its counterparts on both sides of the Civil War a half century later were not.64 In part, individual and collective decisions were influenced by a vigorous anti-vaccine campaign that blossomed in the 19th century and nearly impeded the use of smallpox vaccine. A fringe element emerged from the same Luddite-inspired movement responsible for the rock that had crashed into Cotton Mather’s house a century and a half before. Similar to Jesty’s experience, an 1802 cartoon by the British caricaturist James Gillray conveyed an ironic depiction of commoners vaccinated with cowpox taking on bovine features.65 The irony was lost on many, who believed this an accurate depiction.
Financed by a wealthy and outspoken English businessman and demagogue named William Tebb, an international campaign preached the evils of vaccination against smallpox on both sides of the Atlantic.66 Tebb was a self-admitted British radical who faithfully followed the teachings of characters such as John Bright (best known for battling the British Corn Laws) and the utopian Robert Owen. Today Tebb might be labeled a liberal libertarian. He embraced many causes such as abolition of slavery, vivisection, and the premature burial (for fear many still-living beings were interred). However, Tebb invested the bulk of his passions, as well as a fortune made in the chemical industry, into opposing the use of vaccines. His actions were based on the practice of mystical and occultist philosophies known as Theosophy, and he advocated the rejection of vaccines as a right of the individual over government. A high-profile figure with a penchant for making unjustified claims, Tebb claimed that smallpox vaccinations were responsible for more than 48,000 deaths in England and Wales alone (utterly fallacious figures that are still cited today).67 Such outrageous and unfounded claims incited a scared and confused public, spurring more than 80,000 protestors to march in Leicester in 1885, burning effigies of Edward Jenner and carrying child-sized coffins.68
In the United States, the wealthy firebrand and industrialist John Pitcairn Jr., founder of PPG Industries, took over the mantle from Tebb and fought against vaccination. Pitcairn was an avid follower of the Swedish mystic Emanuel Swedenborg (who reported frequent conversations with angels and demons as evidence that he was the embodiment of the biblical resurrection). Among the beliefs advocated by Pitcairn was homeopathy, and the wealthy industrialist deployed his wealth and power to become a trusted voice of opposition to vaccination. The motivation for his venomous opposition to vaccination was based on a minor blood infection experienced by his son, Raymond, in 1885.69 The blood infection coincided with, and might have resulted from, poor technique during vaccination. However, the Swedenborgian view of the body maintained that contamination (infection) left a scar on the soul and was therefore morally reprehensible. Indeed, the only concoctions felt appropriate to be used therapeutically would be those in which a perceived toxin had been minimized or eliminated because of dilution. For such reasons, homeopaths such as Pitcairn were early converts to the Swedenborgian church.
It is worth expanding a bit on the story behind Pitcairn and the Swedenborgian church. While PPG was originally founded in Pittsburgh, Pitcairn spent much of his life across the state in Philadelphia. The industrialist donated most of the funds used to erect the stunning Bryn Athyn Cathedral just outside Philadelphia. The cathedral’s emphasis on individualism and good deeds gave rise to the legendary Helen Keller and John Chapman (better known as Johnny Appleseed). The church itself was a mainstay of the Philadelphia spiritual community.70
A Little Lie
Another pious, turn-of-the-century anti-vaccinator was Lora Cornelia Little. Born in a log cabin in what is now Waterville, Minnesota, Lora married an engineer who specialized in bridge design. They moved to the East Coast and began a family, giving birth to a son, Kenneth Marion Little, in January 1889.71 Six years later, Kenneth was about to start his primary education in Yonkers, New York, and was legally required to be immunized against smallpox. The cycle of shots was completed in September 1895. In the months thereafter, Kenneth was exposed to many other children, even more so when the family moved from Yonkers to Philadelphia.72 During that tumultuous time, Kenneth was beset by multiple insults and injuries, including persistent ear and throat infections; later he developed measles and diphtheria (a disease to which we will return in a later chapter). According to the certificate of death issued by the Children’s Hospital of Philadelphia, a weakened Kenneth finally succumbed to diphtheria in April 1896. His grieving mother sought for an explanation for this tragedy and concluded that “the artificial pollution of his blood had weakened his constitution and left him at the mercy of the subsequent infections.” Reflecting the Swedenborgian view
s of the time and place (Philadelphia in the time of John Pitcairn, Jr.), she concluded that the artificial pollution that claimed the life of her son must have been the result of the smallpox inoculation. Thus began a lifelong and tireless crusade to preach the evils of the smallpox vaccine. As this cause largely involved children, the most vulnerable population, Little’s campaign appealed to the fears of a public that was particularly sensitive to perceived overreaching of the state during the early years of the 20th century.
Among the vehicles used by Little to spread the word about the anti-vaccinator campaign was the Truth Teller, a subscription-based periodical printed in Battle Creek, Michigan.73 The paper was the re-branding of the Peril, a weekly paper touting the advantages of homeopathy, managed by a rather sketchy group known as the American Medical Liberty League (formerly the National League for Medical Freedom). This group had previously advocated against pure food and drug laws that had been put in place following multiple revelations of corrupted foods and snake oil drugs as depicted in Upton Sinclair’s best seller, The Jungle.74 The Peril primarily served as an advertising opportunity for peddlers of cures for unreal maladies such as “disappointment in love,” “floating kidney,” and “locomotor ataxia.”75 The publication and its products, however, were soon put out of business by the federal passage of the Pure Food and Drug Act, which was signed into law by President Theodore Roosevelt in 1906.76
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