Pox (29 page)

Perceptions of risk—the intuitive judgments that people make about the hazards of their world—can be stubbornly resistant to the evidence of experts. This is because risk perceptions are mediated by experience, by culture, and by relations of power. Certain factors tend to elevate the sense of risk that a person associates with a specific thing or activity, even in the face of countervailing statistical data. A mysterious phenomenon whose workings defy the comprehension of laypeople causes more dread than a commonplace hazard. A hazard whose adverse effects may be delayed, rather than immediate, heightens perceived risk. Significantly, perceived risk tends to spike when the hazard is not voluntarily undertaken. This is especially true when the social benefits claimed for a potentially hazardous activity are not readily apparent to those ordered to undertake it.
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All of which helps to explain why in the fall of 1901 popular perceptions diverged so radically from the official line on vaccine safety. A century after the introduction of Jennerian vaccination, vaccines remained mysterious entities—even to the companies that made them and the physicians who used them. Many American communities had experienced neither a small-pox epidemic nor a general vaccination in over fifteen years, increasing both the public's sense of complacency about the disease and its unfamiliarity with the prophylactic. By force of law, local health boards and school boards ordered citizens to assume the risks of vaccination. Many did, some eagerly, some grudgingly, some only with a billy club against their back. Then the St. Louis and Camden tragedies shocked the nation. Public confidence in the vaccine supply, already shaky, plummeted. Opposition to compulsory vaccination, already strong, surged. Ultimately, these events pierced the veil of official certitude and corporate confidence. Vaccine companies publicly accused each other of peddling poisonous virus. Some health boards suspended vaccination orders. Others launched investigations of vaccine purity and potency. In medical meetings, newspaper columns, and statehouse floors across the country, the debate increasingly turned on a single issue: the right of the state to regulate vaccines. In the fall of 1901, regulation was a controversial idea. A few months later, it was federal law.
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A
South Jersey industrial city of 76,000 people, Camden lay just across the sewage-choked Delaware River from Philadelphia. Times were good. Camden's population had grown by 30 percent during the 1890s. Decent jobs could be had at the Pennsylvania Railroad and in the city's ironworks, chemical plants, shoe factories, cigar companies, lumber mills, oil cloth factories, and woolen mills. Though the presence of immigrants and other newcomers was more keenly felt than in the past, Camden people remained overwhelmingly white and American-born, a generation or more removed from Europe. Crowded tenements of the sort found in New York and Chicago were scarce. Wage earners lived in low-slung neighborhoods of single-family homes. Like most communities, the people of Camden invested their pride and dreams in the rising generation. In September 1901, eight thousand children took their seats in the city's thirty-two public schools. By mid-November, half of those desks would be empty.
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The trouble started on October 7. Eight-year-old Pearl Ludwick took ill with smallpox, followed, in quick succession, by her father, an oil cloth printer, and all seven of her brothers and sisters. Only Pearl's mother was spared the pox; those days must have been among the most trying of her life. Then Pearl's father and eldest brother rose from bed one night and, both delirious with the fever, bumped a table, which knocked over a lamp. The ensuing blaze burned the Ludwick house to the ground—but not before the Ludwicks got out and hundreds of neighbors rushed to the scene. All, of course, were exposed to smallpox. With this improbable chain of events commenced the Camden smallpox epidemic of 1901–2.
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New Jersey had seen little smallpox during the past sixteen years, and vaccination had fallen out of practice. But in 1901 smallpox seemed to be causing trouble everywhere in the United States, including Philadelphia. That summer, anticipating an epidemic year, the New Jersey Board of Health issued a public warning. “An extensive outbreak of small-pox can be prevented with absolute certainty if vaccination of all susceptible persons is secured,” the board declared. “[T]he question now arises, Shall general vaccination be done before a great calamity compels resort to this preventive measure, or must there first be startling losses of life to arouse parents, guardians, school boards, the public, and in too many instances the health authorities also, to a realizing sense of their duty to institute precautions against the spread of this pestilential disease?” No matter how you parsed that question, the message was dead serious. But it took the Ludwick family fire to bring its meaning home to Camden.
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Camden authorities ordered a municipal pesthouse built, and physicians worked long hours to meet the “rush to get vaccinated.” For those families who still needed convincing, the Camden Board of Education announced that it would enforce an 1887 state law that authorized local boards to exclude unvaccinated children. The Camden Board of Health president, Dr. Henry H. Davis, who happened also to be the medical director of the school board, dispatched vaccinators to the city schools. The Camden Medical Society opened a free vaccine station on Federal Street, in the heart of the city. And many residents were vaccinated by private physicians or, on the cheap, by the neighborhood druggist. Within a month, an estimated 27,000 people—more than one third of the city's residents—had undergone vaccination, including five thousand public schoolchildren. And the scraping continued. Across the city, children and adults alike had the sore arms and fresh scars to show for it.
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The state board advised physicians to exercise care when performing the procedure. “The operation of vaccination should be conducted with aseptic precautions,” the board instructed, “and none but glycerinized lymph from a trustworthy producer should be employed.” The board was referring to liquid vaccine that had been treated with glycerin, which acted as a preservative and killed bacteria in the product. Glycerinized vaccine was the state of the art. Whether from a sense of political propriety or fair play to the Philadelphia area's many vaccine companies—including H. M. Alexander's Vaccine Farm, H. K. Mulford Company, and John Wyeth & Brother—the board refrained from endorsing any make of vaccine and offered no advice as to how anyone might distinguish the “trustworthy” from the more dubious products on the market. Trust was a commercial transaction, not a public dispensation.
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In early November, word spread in Camden that a sixteen-year-old boy named William Brower had come down with tetanus. Few of life's hazards caused parents more worry than the infectious disease most folks called lockjaw. The New York writer W. J. Lampton called it “one of the strangest and most horrible maladies known to man.” In 1900, more than 2,200 Americans died from it. The tetanus bacillus was discovered in 1884 in a Göttingen laboratory. Since then, scientists had found germs in hay dust, crumbling masonry, garden soil, and, especially, horse manure. Turn-of-the-century America—from the farms to the cities—crawled with the stuff. Even so, as Army Surgeon General Sternberg noted in his treatise,
Infection and Immunity
, simply ingesting bacilli-rich filth would not cause infection. Nor was tetanus contagious. The bacilli did not grow in the presence of oxygen. It usually took a traumatic event—a wound of some kind, the narrower and deeper the better—to introduce bacilli into a human body in a way that could cause infection. The classic culprit was a rusty nail—not because of the chemical composition of the rust itself, but because it made the surface of the nail rough enough to hold an abundance of bacilli which the sharp, skinny nail could drive home without much bleeding. Every Fourth of July, hundreds of American boys caught tetanus after cutting their hands with toy pistols.
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The symptoms of lockjaw were terrible. William Brower suffered them all. The son of a plumber, the boy had seemed in fine health until he fell suddenly ill around November 1. He suffered a high fever. He felt the telltale stiffness in his face. His jaws tightened like a vise. Excruciating contractions spread from the jaw and neck to all the muscles of the body. His spine arched, as convulsions racked his body. The doctors administered the tetanus antitoxin, a relatively new product with a low rate of success. No one expected the boy to survive. According to the
Philadelphia North American
, William's mother Sarah said, in her grief, “Never, never again shall I have one of my children vaccinated.” William had been vaccinated nineteen days earlier. To his parents there seemed no better explanation for his misery. The trusted family physician who had vaccinated William, Dr. William H. Kensinger, disagreed. “Vaccination doesn't produce tetanus; that I know,” he said.
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Then came the news that sixteen-year-old Lillian Carty was critically ill with tetanus. The daughter of a railroad clerk, Lillian had been vaccinated twenty-one days earlier by Dr. S. G. Bushey, the city coroner and a prominent member of the Camden Board of Health. Lillian's parents posted a sign at their front door, asking passersby to keep quiet, because the slightest noise agitated her and sent her into convulsions. Antitoxin was administered. No one expected her to survive.
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Neither Brower nor Carty was the first child to die. On November 11, Thomas B. Hazelton, age eleven, the son of a shipping clerk, was in the street playing when he started to feel ill, with a pronounced stiffness in his jaw. Someone called for Dr. Bushey, who as the Hazeltons' family physician had vaccinated the boy about three weeks earlier. Never had Bushey seen a patient suffer such “terrible agony.” Less than twenty hours after Thomas took to his bed, he was dead. According to the
New York Tribune
, now covering the Camden story, Bushey moved to set the record straight. “[T]he boy's death was not the result of vaccination,” the coroner declared. But Thomas's parents had doubts. Mr. Hazelton said he might seek legal advice. He wanted to know whether the vaccine used on his boy was pure and, if it was not, whether the manufacturer could be held responsible for his death.
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The next day, November 13, tetanus struck nine-year-old Anna Cochran, the daughter of a teamster. She had been vaccinated about three weeks earlier. The story of little Anna's courage, as convulsions shook her small frame, was, as the New York
Sun
told it, “particularly sad.” Just before she died, on November 14, Anna “turned to her parents and whispered through her clenched teeth: ‘Don't worry, papa and mamma, I'm going to get well.'”
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As parents' initial suspicions swelled into a panic, Dr. Davis of the board of health made a statement to the press. Camden's most prominent physician attributed the tetanus cases to a period of unusually dry and dusty weather. “I am satisfied that none of them have been caused by vaccination,” said Davis, “but by the tetanus germs in the air.” Local physicians formed a unified public front with Davis and the board, insisting that the vaccine they had used was safe. But a few expressed doubts. Dr. Dowling Benjamin, considered a local authority on tetanus, broke ranks. “This talk of germs being in the air is all absurd,” he said. “If that were so there would be more lockjaw than there now is. I think it is highly probable the tetanus germs were in the vaccine tubes before they were sealed.”
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Local newspapermen turned up three more dead children whose deaths by tetanus had previously gone unreported. Eleven-year-old Anna Warrington, the only child of an illiterate ship carpenter and his wife, had died on November 8, after suffering in “great agony.” Six-year-old Frank Cavallo, the child of Italian immigrants (his father was an illiterate rag dealer), had been vaccinated in Philadelphia during a visit to his grandmother; he died three weeks later, on November 9. The other new victim, unnamed, lay buried in the Evergreen Cemetery, believed to have died on November 5. A growing distrust of the authorities strengthened the public's fears. Why hadn't public health officials reported these cases earlier?
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On the night of November 15, Lillian Carty gave up her fight. The doctors had done all they could, the newspapers said, administering antitoxin and trying to ease her suffering as her muscles contracted. “Conscious through it all,” the
New York Tribune
reported, “she suffered frightfully for two days.” Her parents, exhausted from the long ordeal at her bedside, were prostrated in their grief. Remarkably, William Brower was still alive, but in critical condition. The bad news kept coming. The day Lillian died, another child had been diagnosed with tetanus following vaccination. Her name was Mamie Winters. She was eight years old.
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Camden was now in a full panic, and regional newspapers had taken notice. With the tetanus outbreak now weighing far more heavily on people's minds than the continuing smallpox epidemic, city health officials and parents searched, in their own ways, for connections between the lockjaw cases. They found few. The children ranged in age from six to sixteen. No two of them lived in the same ward of the city. None had visited the free vaccination station, and no more than two had been vaccinated by the same physician. As the Camden Board of Health saw things, though, there were significant commonalities. Board representatives observed that most of the children were from “lower class” families (a dubious claim, as Hazelton's father was a shipping clerk; Brower's, a plumber; Carty's, a railroad clerk); that the parents were “ignorant” (also unfair, for most of the parents were at least literate); and that they inhabited a dirty city that had experienced a spell of dusty weather (demonstrably true). For the lay public, the salient commonalities had nothing to do with social status or the weather. All of the children had been healthy until they were vaccinated. Roughly three weeks later each fell ill with lockjaw. Now six of them were dead. Most of the children had received glycerinated vaccine. To these links, the New York
Sun
, in a November 17 report, added another: most of the vaccine used in Camden had apparently come from a single, trusted Philadelphia firm, H. K. Mulford Company.
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