Pox (30 page)

It was probably inevitable that suspicion would fall upon the Mulford Company vaccine farm and laboratory in Glenolden, Pennsylvania, just outside Philadelphia. Mulford marketing materials boasted of the company's vaccine sales in eastern Pennsylvania and New Jersey. When the Camden Board of Health announced its plan for wholesale vaccination, Mulford and Marietta-based Alexander Vaccine Farm vied to corner the market. According to the
Sun
, a local chemist who represented Alexander approached the Camden Medical Society and seemed poised to win the contract for the vaccine station. Mulford countered by offering the society a thousand free points. Demand quickly exhausted that gratis supply, and the society bought more vaccine from Mulford, as did many private physicians. Almost all of the afflicted children had received Mulford virus. Company executives insisted the vaccine was pure. The allegations, they said, had come from pharmacists who served as agents for their rival companies, Alexander and Parke, Davis.
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The parents of Camden demanded a public investigation of the tetanus outbreak. James B. Cochran, Anna's father, swore that if the authorities did not “fix the blame,” he would “spend his last dollar doing it himself.” Every family in the city had cause for concern. Parents whose sons and daughters had dutifully submitted to vaccination were terrified they would be the next to fall ill. (The children were afraid, too. At Lillian Carty's funeral, her schoolmates cried for her and worried for themselves.) Parents whose children had not yet been vaccinated feared that submitting now would expose them to an unacceptable risk of lockjaw.
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Camden families launched a school strike, hundreds of parents declaring that their children would not return to the classroom until the school board rescinded its vaccination order. Some parents also talked about litigation, considering whether to sue the vaccine company or seek a court order to open the schools to unvaccinated children. To a knowledgeable lawyer, neither avenue would have looked promising in 1901. One prevailing principle in tort law (“privity of contract”) insulated manufacturers from liability for injuries to anyone other than those to whom the makers sold the vaccine directly; while another principle (“contributory negligence”) limited a defendant's liability if he could show that the plaintiff had negligently contributed to his own injury (for example, by carelessly letting dirt enter a vaccination wound). Moreover, under New Jersey's wrongful death statute, if the plaintiff's lawyer somehow proved the manufacturer's liability in court, the child's next of kin (normally, the father) would have been entitled only to compensation for his direct pecuniary loss: the child's wages, if any. As for the other legal strategy—seeking a judicial writ to compel school officials to admit their unvaccinated children—two circumstances would have hampered that claim: the school board was acting in accordance with a state law, not merely at its own discretion, and the board had promulgated the order in the midst of an actual smallpox epidemic. In the American legal environment of the era, a school strike was a far more viable option than a lawsuit. But even that option carried a risk: school officials could have had the parents prosecuted for violating the compulsory education law.
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Increasingly, people in Camden asked if the compulsory order had really been necessary. On the day Anna Cochran died, the Camden Board of Health had released its monthly report. There had been just fourteen cases of smallpox since October, with only one fatality. The toll from tetanus was much higher. “Camden people are demanding to know where the benefits of vaccination come in,” said the
Sun
. According to the
Times
, some citizens now saw the health board as an “autocratic” institution, unaccountable to the people.
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Events came to a head on November 18, six days after Thomas Hazelton's death. Camden's vaccine crisis was no longer just a local or regional story. It was a national event. Reports of isolated postvaccination tetanus deaths—more schoolchildren—surfaced from Atlantic City and Bristol, Pennsylvania. Philadelphia, too, reported “several cases of tetanus following vaccination, but no official action has been taken.” As telegraph wires fed newspapers from Charlotte to San Francisco the latest from Camden, journalists dusted off other stories from the past year. “The tetanus bacillus has admittedly found its way into commercial virus to such an extent as to have given serious trouble in at least five widely separated districts, and probably in isolated cases wherever vaccination is practiced,” said the
Times
. Cleveland had lost four people to postvaccination tetanus during the past year. Previously, postvaccination tetanus was a rare complication. One investigator would turn up more than sixty U.S. cases from 1901 alone; most had occurred in November. All of those local events and stories seemed connected, like an epidemic, creating a widening sense of collective connectedness and complicity that transcended local political boundaries.
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Also on November 18, the St. Louis coroner announced his verdict regarding the first seven deaths from tetanus that had followed the administration of diphtheria antitoxin to children in that city. Citing bacteriological tests, the coroner said the cause of the deaths was the administration of antitoxin containing tetanus toxin. The city health department, not a private firm, had prepared the antitoxin—an experiment in public production that had won the department no small amount of criticism from private companies and druggists. All of the tainted antitoxin had been produced from the blood of a single animal, a horse named Jim, “stabled at the Poorhouse Farm.” Jim had developed tetanus in October and was put down. But serum had been drawn from Jim before his symptoms became apparent, and the serum had not been destroyed. Compounding the public relations disaster was the revelation that the job of bottling the serum had been entrusted to a janitor. The coroner charged the health department with negligence. American newspapers readily extrapolated from the coroner's findings to the vaccine cases. “No other suggestion is reasonable,” said the
Duluth News-Tribune
, “than that the unwelcome bacilli secured a lodging place in the virus and the antitoxin in the laboratory.”
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The tetanus scares triggered opposition to vaccination in many American communities. In Rochester, New York, in the midst of its own small-pox outbreak, parents responded to the news from Camden, 350 miles away, by refusing to allow their children to be vaccinated. Two schools were “practically closed for want of attendance.” In response, the city health officer, according to the
New York Tribune
, “deprecated the displaying of the Camden news.” His peers in many other American communities shared his frustration.
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From the beginning of the crisis, Camden health officials and doctors had maintained a united front in defense of vaccination. But with six children dead so far, the schools half-empty, and a national scandal brewing, the board of health called a halt. On the night of November 18, the members passed a resolution ordering physicians to cease vaccination until further notice. The board advised the school board to suspend enforcement of the vaccination law, which that body did the following day. The health board launched a scientific investigation to determine the causes of the tetanus outbreak and, as James Cochran had demanded, fix the blame. The Mulford Company promised its full cooperation.
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The board members were not the only medical men determined to settle these same questions. Working on their own, three other men had quietly begun their own investigations—inquiries that would push the limits of medical science. Two of them, Robert Willson and Joseph McFarland, were physicians from neighboring Philadelphia. Willson had recently lost a patient to postvaccination tetanus. McFarland was one of America's leading bacteriologists; his work with diphtheria antitoxin had put Mulford on the map, but he had left the company for academia and a consulting job with Mulford's rival, Parke, Davis. The third investigator, Milton J. Rosenau, was an officer of the federal government, working in a small Washington laboratory, within the U.S. Marine-Hospital Service, that would one day be known as the National Institutes of Health.

All three men believed vaccination was medical science's greatest gift to humanity. All sought an answer to the crisis that had discredited that operation during the most serious visitation of smallpox the nation had seen in years. Their investigations ensured that the Camden Board of Health would not have the last word on the matter.

 

 

T
he Camden tragedy cast unwanted light upon a hitherto little-known sector of the U.S. economy. Part animal husbandry, part laboratory science, the vaccine industry exemplified the distinctive historical inbetweenness of life at the century's turn. On city streets, automobiles and streetcars vied for the road with horse-drawn carriages. In the public sphere, a new scientific rhetoric of social statistics and structures pressed against the older Protestant moralism of individuals and strictures. And in one of the most profitable manufacturing sectors of the U.S. economy, future giants of the nation's pharmaceutical industry—companies such as Wyeth and Parke, Davis—were making names for themselves by harvesting pus from the undersides of barnyard animals. Poised between the stable and the laboratory, the farm and the firm, the vaccine industry embodied a world in transition. Of course, the vaccine makers had no way of knowing what their industry would one day become, but the most innovative among them dared to dream big. They forged close ties with government health departments and universities. And they embraced medical science—not just for the technical innovations that science enabled but for the credibility it offered to an industry built upon incredible promises.
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Although vaccination arrived in America in 1800, vaccine manufacturing did not emerge as a commercial industry until the 1870s, with the shift from “humanized” to “bovine” virus. Of course, Edward Jenner had obtained his original vaccine material from a cow, albeit by an indirect method: he took the “lymph” from a pustule on the hand of a milkmaid infected with cowpox. Uncertain about the origin of this disease, the doctor named it “variolae vaccinae,” smallpox of the cow. And though Jenner speculated that the disease might have originated in an affliction of horses (and he may have been right), the name vaccine stuck.
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Naturally occurring cases of cowpox were rare. Fortunately, Jenner established that vaccine could be serially reproduced in humans. The method entailed taking fluid directly from the vaccination vesicle on the arm of a donor (“vaccinifier”), usually a healthy young child, and applying the virus to the scratched arms of an assembly of recipients. Humanized virus: vaccine without the
vache
. The possibilities were breathtaking, as the Balmis expedition showed the world in 1803–5, transporting vaccine in the arms of orphans to the Spanish colonies of the Americas and the Philippines. In England, the National Vaccine Establishment assumed responsibility in 1808 for maintaining a supply of humanized virus, through serial “arm-to-arm” transfers. The virus could also be preserved and transported by drying the fluid on pieces of thread, quills, or ivory points; or by peeling the crust from a vaccination sore. The lymph-saturated crust could be carried or even sent in the mail; the vaccinator would triturate (crush) and moisten the crust, producing a pasty vaccine material, and then set to work. A North Carolina physician recalled vaccinating his entire town in 1854 with a “very ugly little scab” that he received by post from Wilmington.
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Humanized virus worked. When properly collected and used, it took “with great regularity” and produced immunity for years. But there were problems. If the vaccinifier was not as healthy as she appeared, the virus could communicate other human diseases, including erysipelas (an acute skin infection) and syphilis. In Rivalta, Italy, in 1861, sixty-three children were vaccinated with material from the vaccinal sore of a single, seemingly healthy infant. Forty-six of the children fell ill with syphilis, several died, and some passed the disease to their mothers and nurses. The risks of arm-to-arm transfer inflamed antivaccination sentiment almost everywhere it was practiced. Herbert Spencer called it “wholesale syphilization.”
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A second disadvantage of humanized virus was the challenge, even in a densely populated community, of keeping a fresh supply on hand. For a small town or sparsely settled rural area, keeping up an arm-to-arm relay or a good stock of crusts might prove impossible. Moreover, some physicians believed that humanized virus became attenuated or compromised over time, with the ever increasing distance from the original bovine source. Humanized virus had one other major shortcoming, which only became fully apparent in retrospect. There was never much of a market in it.
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The idea of using cows, instead of people, to manufacture cowpox first took hold in Italy. Throughout the century, in Europe and America, some vaccine propagators practiced what came to be called “retrovaccination”: inoculating heifers with humanized virus, either to mystically restore some bovine quality to the vaccine or to simply make animals do the work. But the production of the stuff that came to be known as “true animal vaccine” or “bovine virus”—and that would launch a new industry and market—did not catch on in Europe until the 1860s. The idea was to inoculate a heifer with seed virus obtained from a naturally occurring case of cowpox (
not
with humanized virus) and to keep the strain running from calf to calf in a continuous relay, all the while harvesting vaccine for use in humans.
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