Robert D. Hicks, PhD, Director, Mütter Museum/Historical Medical Library, The College of Physicians of Philadelphia, contributes today’s blog post. In preparation for an exhibit on Civil War Medicine at the Mütter Museum in 2012, Dr. Hicks has been researching, among other topics, the occurrence of spurious vaccination in the Civil War. Spurious vaccination was smallpox vaccination that either did not produce immunity in the recipient or that resulted in complications such as vaccination site infection, or that spread a communicable disease such as syphilis. While physicians in the United States frequently used humanized smallpox vaccine during the Civil War, French physicians at the time were popularizing a mode of smallpox vaccination that relied solely on serial propagation of vaccine in cows. Human transmission of smallpox vaccine disappeared by the turn of the century.
According to Joseph Jones, MD, Professor of Physiology and Pathology, University of Nashville, vital medical research was “brought to a sudden and unexpected close, by the disastrous termination of the civil war.” Writing in 1866, in a radically changed and changing South in the aftermath of the Civil War which ended the previous year, Jones expressed frustration that a Confederate medical investigation on smallpox vaccinations “was destroyed during the evacuation of Richmond.” Confederate medical records in Richmond, Virginia, disappeared after the victorious Union Army torched the city. Vexed by these circumstances, Jones surveyed physicians throughout the South who served in the Confederate Army to elicit data about “spurious vaccinations” and resurrect the destroyed report. Spurious cases were smallpox vaccinations of soldiers deemed “accidents” because they conferred no subsequent immunity to the disease or, compounding misery, introduced other diseases incident to vaccination, particularly syphilis. Jones paints a dire portrait of a Confederate Army that experienced far too many deaths and disabilities due to spurious vaccinations.
Jones published the survey results in the Nashville Journal of Medicine and Surgery, and in 1867 printed and circulated an offprint entitled, Researches upon “Spurious Vaccination,” or the Abnormal Phenomena accompanying and following Vaccination in the Confederate Army, during the Recent American Civil War, 1861 – 1865. Written undoubtedly with Union troops still occupying Tennessee as Reconstruction fashioned a new social order, Jones’s survey is clinically fascinating for its empiricism about vaccinations gone wrong, its tone of urgency barely disguising desperation, and the window it opens on the new social world of the Reconstruction South. (1)
Jones and his colleagues found cases of spurious vaccinations so prevalent that physicians:
instituted a series of experiments upon the inoculation of cows with small-pox matter, in order to produce, if possible, cow-pox, from whence a supply of fresh and reliable vaccine might be obtained. It was our design to carry out an extensive series of investigations upon the various secondary afflictions following vaccination, and to determine, if possible, what contagious principles could be associated with the lymph of the vaccine vesicle. (p.4)
Based on his survey, Jones offered several causes of spurious vaccinations:
- The Confederate Army’s “depressed forces,” owing to the demands of hard campaigning with consequent exhaustion, exposure to harsh environments, and poor nutrition;
- The introduction of infections from previously vaccinated soldiers who had been “affected with some skin disease at the time of the insertion of the vaccine virus”;
- The harvesting of “decomposed dried vaccine, lymph, or scabs” from vaccinated soldiers;
- The extraction and application of lymph from soldiers and its introduction in others who were already “laboring under the action of the poison of Small Pox”;
- The harvesting of scabs, dried vaccine, or lymph from soldiers who had erysipelas [a bacterial skin infection usually attributed to Streptococcus]; and
- The harvesting of scabs, dried vaccine, or lymph “from patients suffering from Syphilis, at the time, and during the progress of vaccination and the vaccine diseases.”
To arrive at this list of causes, Jones proceeded with admirable skepticism and caution in evaluating anecdotal reports. In his letter to fellow physicians, he wrote that “It is important that we should carefully distinguish the accidents which result from carelessness in the selection of the [vaccine] matter, and from ignorance of the true character and progress of the vaccine disease.” Jones particularly invites attention to the inadvertent transmission of erysipelas and syphilis. He cautions his comrades, though, that his inquiry is not intended to disparage the value of vaccination:
We should exercise the utmost caution in discussing the value of vaccination … to bring it into disrepute with the public; for all conscientious physicians and lovers of mankind will agree that this question … comes home to every individual of the human race … I should disclaim all design of decrying vaccination when properly performed.
Jones offers readers a brief history of vaccination in which he scrupulously outlines the early mistakes and misjudgments occasioned by overconfidence in the newly-invented vaccination procedure. He is bold in stating that most mistakes have arisen “directly or indirectly from the ignorance, and inattention” of physicians. Nonetheless, Jones can visualize a future free of smallpox torment for, through Edward Jenner, “the world has been furnished with the means of completely eradicating this terrible scourge.”
Former Confederate surgeon James Bolton, MD, who practiced at Chimborazo Hospital in Richmond, Virginia, contributed his own observations to the report. The Surgeon-General of Richmond ordered him to propagate the virus among children and vaccinate all government employees. In tracing the vexing cases of vaccination accidents, he posited “some occult influence, atmospheric or other” that may have affected the health of people from whom vaccination scabs, or crusts, were collected. Bolton therefore set about canvassing “the plantations in the interior of Virginia, vaccinating whites and negroes, and retracing … steps for the purpose of gathering the crusts.” He collected 800 crusts, “mostly from healthy negro children.” Processed into vaccines, these crusts proved effective. Chimborazo Hospital, he reports, obtained the virus “from the arms of healthy infants.” All things considered, Bolton found that the application of “good” vaccinations to unhealthy people nevertheless protected them, but with “abnormal sequelae.” Bolton concludes, as Jones does, that poor nutrition, exhaustion, and exposure conspired with people of poor “vital powers” to produce the attributes of spurious vaccines.
Jones considers the recent smallpox outbreak in Mobile, Alabama, the previous winter and, mindful of the foregoing analysis by Bolton, offers the view that the explanation for the new outbreak was “very obvious”: Reconstruction. Suddenly liberated slaves, “freed from their accustomed restraint and the fostering care of their former masters,” now congregate in towns. Having never been vaccinated, they wander, susceptible to disease, and present a threat to everyone. “Fully nine out of ten of the deaths from Small-pox have been among the Freedmen.” People of “the better class,” however, who take better care of themselves, have arranged for re-vaccination and therefore experienced only mild cases.
The report concludes with cautious but hopeful observations. The dilemma, however, observed abundantly by physicians during the war remains:
Suppose you are called upon to vaccinate half-a-dozen children, and it is performed on them all at the same time and with the same virus. What happens? One may not receive it at all, in all the others it may take showing its characteristic vesicle [raised cavity with the vaccine], but affecting the individuals in various degrees, thus showing different grades of susceptibility. In one good vesicle will appear without constitutional symptoms, in another the vesicle may be accompanied by high fever, glandular swellings &c, and the others will present grades of effect.
So, thus encapsulated, what are the implications for the South? And for how long, asks Jones, are vaccinations effective? Do they produce lifelong immunity? In addition to the social disorganization and confusion of authority following the war, southerners now registered the fear of new epidemics of smallpox. Whatever thoughts a white southerner might have had on seeing migrating black families, newly freed, traveling along common roads, the threat of infection seems to have been a paramount concern. White people’s views of uneducated black people on the move registered apprehension, and the stereotype of poor people as unintelligent and unkempt in body and appearance strengthened worries that these itinerants spread smallpox. Thus, Jones’s report, while reporting on wartime circumstances, enlists former army colleagues to pool data to give scientific support to future decisions about public health policy in the South.
In the … distressed condition of the Southern States, cut off from the surrounding world, with the necessity of Vaccinating the entire male population capable of bearing arms, and without any means of obtaining fresh and reliable [vaccine] matter outside of the Confederate States, the experience of Medical Officers of the Confederate Army possesses a high and peculiar value
Clearly, Jones feels that the South still exists within a cultural cordon, incompatible with the North. Not only do southerners worry about the inversion of the class order, but they worry that the upheaval will make them sick.
(1) The observations by Jones and his colleagues are echoed in a fascinating correspondence between Henry Austin Martin (1824-1884), a former Union Army surgeon, and Thomas Fanning Wood (1841-1892), a former Confederate Army surgeon, found in the North Carolina State Archives. Years after the war, both men, advocates of vaccination, corresponded about their experiences regarding spurious vaccinations, the ravages of smallpox, and techniques for obtaining reliable vaccines. See John Joseph Buder, Letters of Henry Austin Martin: The Vaccination Correspondence to Thomas Fanning Wood, 1877-1883. Master of Arts thesis, University of Texas at Austin, 1991.