Pox (33 page)

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.
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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.
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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.”
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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.”
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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 procedure: the government compelled vaccination, but it would not vouch for vaccine.
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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.”
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The vaccine crisis seemed to require a new role for the state in controlling production. But what sort of control? Like their European social-democratic counterparts, progressive reformers in the United States insisted that certain areas of life were too precious to leave entirely to the unregulated market. This call for a sort of decommodification—to replace capitalist price with government discipline—was a common thread running through a great many otherwise disparate reform causes, from the movement for public ownership of streetcars to the campaign to ban child labor. The disasters in St. Louis and Camden convinced many physicians and health officials that vaccine production had been left to the free market for too long. “The lesson we have principally to learn from these catastrophes,” said Dr. Dalton of New York, “is the necessity of eliminating commercialism from matters pertaining to public health.”
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The professional debate centered on two options. The first was for states to manufacture their own vaccines, in effect socializing the industry (as Japan had done in 1896). Eugene A. Darling, director of the Cambridge, Massachusetts, Bacteriological Laboratory, noted the ethical clarity in this approach. He said, “The State compels the child to be vaccinated, and should furnish the lymph for the operation, guaranteed to be pure and efficient.” The other option was to bring commercial vaccine makers under the discipline of a new regime of licensing and inspection. Since vaccines were an interstate business, most supporters of regulation called for the involvement of the federal government. This, too, was a bold idea: the federal government did not regulate drugs or biologics manufactured in the United States. (Since 1848, federal law had banned the importation of adulterated or spurious drugs, but that law did not touch domestic manufactures.) The entire professional debate took place in the context of rising antivaccination sentiment. In early February, the Massachusetts legislature held hearings on a bill to repeal the state's compulsory vaccination law. The committee heard an emotional appeal from the mother of Annie Caswell, a five-year-old Cambridge girl who had died the previous month from tetanus after vaccination. The bill failed. But that effort and others like it helped keep the vaccine purity question before the press.
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The idea of government production, which
American Medicine
dismissed as “almost out of the question,” met with powerful opposition from vaccine makers and the druggists who sold their goods. The makers had long enjoyed a cozy relationship with state and local health boards, aggressively seeking their contracts and endorsements. And, of course, every vaccination order created a demand for commercial products. Not surprisingly, the makers did not welcome competition from their longtime sponsors. “A Board has no right to enter into commercial enterprises,” the
St. Louis Medical Journal
declared in 1898, a few years after the city health department introduced its ill-fated antitoxin. That same year, the New York County Medical Society sponsored a state bill that would have forbidden the Tammany-controlled New York City Health Department to sell its surplus biologics; the bill failed. In 1900 and 1901, manufacturers and druggists urged Congress to stop the Department of Agriculture from providing ranchers with free vaccine for blackleg, a disease of cattle and sheep. At a time when some of America's more progressive municipal governments were taking steps to provide their citizens with necessary services—including water, electricity, and gas—production of vaccines and antitoxins by local health boards was met with slippery-slope charges of “municipal socialism.” (Bona fide socialists bristled at the association. Socialist Labor Party leader Daniel De Leon countered, “The vaccination laws are capitalist laws: they were framed by capitalist legislatures; they have been passed upon by capitalist courts; they are enforced by capitalist officials. From first to last the spirit of capitalism has dominated the whole procedure.”)
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In the winter of 1901–2, druggists and vaccine manufacturers waged a protracted campaign to beat back government production in the few places it already existed. (The great exceptions were in the new U.S. colonies in Puerto Rico and the Philippines.) On the U.S. mainland, the vaccine interests held up the St. Louis tetanus outbreak as the tragic but inevitable result of placing production in the hands of a political machine. “It is difficult enough to keep politics pure,” said the Minneapolis-based
Medical Dial
, “but it is impossible to make pure political antitoxin.” Seizing the moment, the makers and druggists pressed Mayor Seth Low of New York to stop the city health department from the “destructively competitive” practice of selling its highly regarded vaccine and antitoxin on the market. Even reformers worried that municipal governments controlled by political machines would produce products more dangerous than those already available on the commercial market. Others insisted there was something un-American about the whole idea. “No government has the right, morally, legally, or commercially to enter into any business for pecuniary profit,” declared the
Medical Record
. Neither purity of product nor cheapness to consumers could justify it. “A municipal laboratory is not a shop.”
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The so-called Continental method of monopolistic government production was not going to happen in the United States. Government regulation was controversial enough. Here, too, there were European models. In Italy, which had the most extensive system of regulation in Europe, would-be makers of any biologics (including antitoxin and vaccine) had to first secure the consent of the interior minister. (Germany, France, and Russia also had national systems of control covering specific biologics). In the United States, some commentators objected that any such system was impractical and contrary to the American way. “In a country as large as ours, and with our republican form of government,”
American Medicine
commented, “it would be very difficult, if not impossible, to carry out the supervision suggested.” In the United States a dozen commercial establishments made diphtheria antitoxin. Each had 25 to 250 horses. Was the government really prepared to “test the serums of 100 or more bleedings a day” at sites around the country?
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But by the spring of 1902, it increasingly seemed clear to the medical profession that a national licensing and inspection regime was an idea whose time had come. The events in Camden and St. Louis had made such a move seem inevitable to organized physicians and vaccine makers alike. In late March, the
Medical Record
described the emerging professional consensus. “Of late, owing chiefly to the accidents which have occurred recently in this country from the use of diphtheria antitoxin and vaccine virus, there has been a movement in favor of Government control of such products,” the journal said. “This proposition is not only highly proper under present circumstances, but absolutely imperative.” But regulation was as far as this journal, or the profession, was ready to go. Government competition with free enterprise was unacceptable. Much the same conclusion was reached in an informal discussion at the annual meeting of the American Medical Association that spring. The old arrangement in American public health law—which allowed compulsory vaccination with unregulated products—was no longer tenable. A resolution introduced to the Homeopathic Medical Society of New York caught the spirit of many others: “when the State or local authorities enforce vaccination they are in justice bound to surround it with all the modern safeguards.”
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There were a few precedents for such state-level regulation. In the most ambitious effort, Pitfield's grand tour of American vaccine farms for the Pennsylvania board in 1896 had demonstrated just how revealing on-site inspections could be. But the power of a state health board only reached so far; it could only use such information to control vaccine sold or produced within the state. The vaccine business was an interstate trade; the larger firms like Parke, Davis even manufactured and marketed their wares beyond the nation's borders. An effective system of government regulation, many reform-minded physicians concluded, would have to be a federal government responsibility. Rosenau's study of the vaccine market had shown the potential of that idea; in fact, Rosenau did not conceal his belief that the Marine-Hospital Service (with his laboratory) was the natural agency for the job.