The Michigan State Medical Society reported in 1930 that 'whooping cough is a very fatal disease for young children and unfortunately it is difficult to make parents understand that they must protect their children.... There is little that can be done to control its spread except to avoid the opportunity for infection.' (1) Throughout the 1920s, whooping cough, also known as pertussis, took more young lives annually than did the better-known childhood scourges of diphtheria, scarlet fever, measles, and tuberculosis; on average six thousand American children succumbed to whooping cough each year during this decade. (2) In 1932 Michigan Department of Health bacteriologists Pearl Kendrick and Grace Eldering forged a mutually beneficial partnership with the community of Grand Rapids that would, within four years, produce a viable whooping-cough vaccine. (3) This collaboration, which would endure though the 1940s, made it possible for Kendrick and Eldering to study the pertussis bacillus, develop a potent pertussis vaccine, and conduct large-scale, controlled field trials that demonstrated the vaccine's effectiveness.
By the time Kendrick and Eldering began developing and testing their pertussis vaccine, diverse Progressive-Era reformers had been working for decades to protect the health of the nation's citizens. They had employed a wide range of strategies, including urban sanitation, bacterial and chemical analyses of water and milk, health education, and inspection of immigrants for communicable diseases. Kendrick and Eldering's work on pertussis built on three public health trends that have received much attention from historians: the development of maternal and child health programs in the United States and around the world, the emergence of the science of bacteriology, and the growth of research on biological products. In an era when children were viewed as both national and natural resources for the nation's growing role on the world stage, the health and welfare of America's youngest citizens began to receive heightened attention from the public health community. (4) New public health advances in bacteriology provided local communities and state boards of health with a myriad of options for reducing infant, childhood, maternal, and general mortality. (5) The development of biological products, including Kendrick and Eldering's vaccine, would also play a major role in improving the nation's health. (6)
State and local health departments faced difficult funding decisions as the Great Depression forced them to stretch falling revenues in order to meet the increased public health challenges that typically accompany high unemployment and low incomes. (7) It was during these trying economic times that Kendrick and Eldering motivated the health-conscious Grand Rapids community not only to adopt extant vaccines, but also to actively sponsor and participate in innovative public health research. (8) The scientists' creative outreach work and their successful efforts to raise funds by combining local public and private donations; state funds; locally allocated federal monies; and, later, direct federal grants, reveal the extent to which local support was vital to research in the years before the large-scale infusion of federal research dollars during the Second World War.
Pearl Kendrick and Grace Eldering did not begin their careers with the goal of eliminating whooping cough. Like many scientifically minded women in the early decades of the twentieth century, they took advantage of the educational opportunities that were becoming available to women. Kendrick received her BS in liberal arts from Syracuse University and studied bacteriology at Columbia University; Eldering majored in both English and biology at the University of Montana. Both women began their careers in education: Kendrick taught high-school science and served as a school principal in New York; Eldering taught elementary school in Montana. Neither would remain in education long. (9)
The world of public health in general, and state health departments in particular, offered entry-level employment opportunities for women. Pearl Kendrick's correspondence reveals that at times this area offered women higher-level positions as well. (10) During the Progressive Era, many cities and states funded laboratories for the routine analysis of both water and milk; only a few states, New York, Massachusetts, and Michigan, also supported laboratory research for developing better methods of preventing disease. (11) Kendrick's unique combination of scientific ability and interpersonal skills allowed her to advance rapidly in New York's and Michigan's research-focused departments of health. From her days as a student and a teacher, Kendrick earned the reputation for being, as one recommendation noted, 'a first class student, thorough, accurate and rapid.' (12) Kendrick continued her education while she was employed as a science teacher and principal by the Saint Johnsville Public Schools. In the summer of 1917 she did graduate work in bacteriology under Hans Zinnser at Columbia. In a recommendation letter, Saint Johnsville Public Schools Supervising Principal John R. Palmer described Kendrick as possessing 'an unusual amount of executive ability and rare common sense.' (13)
In 1919 Kendrick left education and began working as a laboratory assistant for the New York State Department of Health Laboratories. (14) A year later, the Michigan Department of Health's Bureau of Laboratories Director C. C. (Cy) Young met Kendrick, recognized her scientific ability, and recruited her. 'I am sure that we can make it interesting for you and there is every chance for advancement,' he assured her. (15) When Kendrick accepted Young's offer, she noted that 'it was a rather hard decision to make as I had definitely accepted a proposition made me here which meant quite an advancement. However, the idea of helping [to] work out the problems of a growing organization appeals to me strongly.' (16) Her laboratory work in Lansing drew the notice of well-respected health figures. She would receive and reject offers from other nationally known health departments including one from William Park's Department of Health Laboratory in New York City in the summer of 1923. (17) Young would reward her loyalty; Kendrick was at the helm when the Michigan Department of Health opened the Western Michigan Branch of the State Laboratory in Grand Rapids in 1926. Throughout her career, she would be called upon by the local, national, and international scientific communities to serve as a leader in public health initiatives.
Teaching elementary school did not hold Grace Eldering's interest for long. She returned to college to study bacteriology and then worked in a laboratory in Helena, Montana. On Labor Day in 1928, seeking new opportunities, Eldering boarded a train for Michigan to begin a six-month stint as an unpaid volunteer in the department of health's Lansing laboratory. In 1932 Kendrick brought her to the Grand Rapids laboratory to participate in pertussis research. (18) Like Kendrick, Eldering would become a valued and influential member of the public health community. She would take over the Western Michigan Branch of the State Laboratory in 1951, when Kendrick became a resident lecturer in the Department of Epidemiology at the University of Michigan's School of Public Health.
Like many in the public health community, Cy Young agreed with Herman Biggs, Chief Medical Officer of the New York City Department of Health, that 'public health is purchasable and that communities may within natural limitations determine their own death rates.' (19) Young lobbied Michigan's Governor Alex Groesbeck and the state legislature for increased public health funding to lower Michigan's death rate. In 1921 the legislature responded to Young's pleas, authorizing funds to manufacture, purchase, and distribute biologic products related to diphtheria control, including antitoxins and vaccines. The 1923 report of the Michigan Department of Health's Bureau of Laboratories stressed that 'to make this [State] laboratory of maximum value to the physician, the staff is encouraged at all times to carry on research work and special investigations of problems that arise in the course of our routine work. Every incentive is given the workers in the laboratory to confirm suggested methods and compare all new methods with the standard methods of procedure of our laboratory so that the technique and methods of examination will be comparable with the very best modern practices.' (20) Such research efforts quickly began to pay dividends. Two years later, when Michigan's production of antitoxin offered a more affordable product than commercial serums, the state's department of health created its own Biological Products Division to manufacture biologics.
The Michigan Department of Health was remarkably successful in lowering the death rate in the state in the years from 1920 to 1940. This can be attributed to several steps the department took, including decentralizing care; improving education and outreach; adopting, incorporating, and extending federal priorities and programs into the state's extant channels; and, most importantly for the pertussis program, making a commitment to pursue cutting-edge research. (21) The Bureau of Laboratories laid 'a foundation for future effort' by fostering 'local interest and local responsibility' so that public health work could be accomplished around the state with 'a minimum of state supervision.' (22) The success of the diphtheria-prevention campaigns of the 1920s illustrates the strength of this foundation. The Michigan Department of Health's Division of Child Hygiene and Public Health Nursing, working in conjunction with local health departments, held clinics around the state where nurses educated parents, checked children's throats, and distributed vaccines free of charge to all Michigan residents, regardless of income. (23) In the 1930s the health department supported Kendrick and Eldering's pertussis research by providing levels of funding, laboratory space, and personnel similar to those provided for the diphtheria-prevention campaigns.
At the same time it was pursuing health education and vaccine distribution, the health department enjoyed an international reputation for research and outreach that drew health authorities from around the world to Michigan (with funding often provided by the Rockefeller Foundation) to study the Bureau of Laboratories' successful operations. (24) Michigan was able to maintain this premier status because of Cy Young's commitment to keeping his staff up to date on the latest scientific techniques. Kendrick and Eldering would take full advantage of the educational opportunities, release time, and encouragement that Young offered. Kendrick studied serology and pathology at the University of Michigan during the summers of 1928 and 1931. (25) In 1930 she received a grant from the Rockefeller Foundation to complete her ScD at Johns Hopkins University's School of Hygiene and Public Health. (26) In 1942, after the initial studies on pertussis were completed, Eldering also earned her ScD from Johns Hopkins. At Johns Hopkins, one of the premier public health institutions in the nation, both women learned cutting-edge laboratory and epidemiological techniques and also forged valuable relationships with health professionals from around the world. (27)
Kendrick and Eldering's research on pertussis meshed comfortably with both Michigan's and Grand Rapids's devotion to devising creative strategies to protect public health. To bring their research to fruition, Kendrick and Eldering would actively mobilize diverse segments of the state and local communities during a time that, at first glance, would seem to have been unlikely to encourage such research. Indeed, during the early years of the Great Depression, funding for research was severely limited or nonexistent at the State Laboratory in Grand Rapids. In 1930, two years before Kendrick and Eldering began their pertussis studies, the Laboratory Section of the health department reported that its operating budget had not increased in six years despite a 10 percent to 20 percent increase in work volume. This lack of funds had forced the department to 'discontinue entirely' all research work. Director Young and others, however, were determined to maintain the international reputation of the state's research program. (28) By 1931 the Department of Health had fixed upon an innovative and viable solution to protect both the health of Michigan's populace and the department's research agenda. By shifting some of the routine analyses of such items as milk and water to city and local laboratories, the state's laboratories hoped to free themselves to devote more attention to 'control and equalization of the work of municipal and county laboratories, manufacture of biologic products, and investigations leading to new methods of procedure.' (29) In reality, however, the state's laboratories would still have to spend much of their time on routine work.
Kendrick and Eldering recognized that this shift in priorities offered them the opportunity to initiate their research program. In 1932, shortly after she was named the Associate Director of Laboratories and chief of the Western Michigan Branch Laboratory, Kendrick wrote to Young for permission to begin research on whooping cough, a disease that had devastated Grand Rapids in 1932. (30) He agreed, and once the day's routine water and milk analyses were completed, Kendrick and Eldering were granted the freedom to use the state's laboratory to conduct their research. As Eldering recalled in a 1984 interview: 'When the work day was over, we started on the research because it was fun. We'd come home, feed the dogs, get some dinner and get back to what was interesting.' (31) Pertussis research would, however, soon become part of the Western Michigan Branch's daily work.
Kendrick and Eldering built their pertussis studies upon the work of earlier researchers. French scientists Jules Bordet and Octave Gengou had described the organism, Bordetella pertussis, in 1906. (32) Within ten years American pharmaceutical companies, including Mulford, Eli Lilly, Swan-Myers, and Abbott Laboratories, had prepared various pertussis and mixed-sera pertussis vaccines that were designed to both treat and prevent whooping cough. (33) None of these commercial vaccines proved to be effective, however. In 1931 the appointed referee for the American Medical Association's Council on Pharmacy and Chemistry found no 'evidence even for the presumptive value of stock or commercial vaccines' because 'the pertussis vaccines seem to have absolutely no influence [as a preventive], and after the disease is thoroughly established even freshly prepared vaccines seem useless.' (34)
These commercial preparations were failing, but other sectors of the research community were making progress in creating a viable vaccine. In the 1920s Thorvald Madsen of the Danish Serum Institute in Copenhagen sparked the interest of bacteriologists around the world when he reported that vaccine prepared from freshly isolated B. pertussis cultures offered some protection during two outbreaks of whooping cough in the Faroe Islands. (35) In 1931 the English scientists P. H. Leslie and A. D. Gardner announced their research describing four antigenic groups or phases for B. pertussis, highlighting the importance of selecting appropriate cultures for vaccine production. (36) Between 1928 and 1933, Evanston, Illinois, pediatrician Louis Sauer and his assistant, Leonora Hambrecht, demonstrated that an effective vaccine could be produced; although their six controls became infected, none of the more than three hundred children immunized with fresh vaccine contracted whooping cough despite being encouraged to play with infected siblings. (37) Further studies were still needed before a wide-scale vaccination campaign could begin. Kendrick and Eldering joined private physicians and scientists from research institutions, universities, drug companies, and public health laboratories, who sought to accurately diagnose the disease, determine the optimal quarantine length, understand the bacteriology of the disease, and, ultimately, develop and evaluate vaccines. (38)
Through their outreach efforts, Kendrick and Eldering convinced diverse segments of the city's population to participate in their research project. Grand Rapids's devotion to maintaining the health of its citizens and its business climate made the scientists' work easier. The Grand Rapids Common Council established a health committee in 1857, organized a board of health in 1871, and appointed a full-time health officer in 1917. (39) In 1922 W. J. V. Deacon, Director of Communicable Diseases and Vital Statistics for the Michigan Department of Health, praised Grand Rapids for having an 'efficient health officer, who knows his business' and a 'well organized city health department in charge of trained men' that took positive steps to protect the city's children from childhood killers. (40) Indeed, in 1926 the Grand Rapids City Commission converted a tuberculosis sanitarium into the Western Michigan Branch Laboratory, the facility where Kendrick and Eldering would conduct the state's regular analyses and their groundbreaking research.
Support for health programs extended beyond the city's bureaucracies. Starting in the early 1920s many of the civic groups in Grand Rapids, including the Parent Teacher Associations, the Chamber of Commerce, and the Visiting Nurse Association, annually joined forces with the federal Children's Bureau, the State Department of Health, and the Grand Rapids Department of Health to hold health clinics for preschool children and conduct 'summer round-ups' to screen school children for correctable 'defects.' (41) In May 1930 the National Congress of Parents and Teachers awarded Michigan a medal for being the state that registered the greatest number of school children in the summer round-ups. (42) Screenings and clinics also provided opportunities to distribute vaccines. In 1928 Grand Rapids was the only city in the U.S. with a population greater than five thousand to have no deaths from diphtheria, a remarkable achievement for a city that had once had one of the highest diphtheria death rates in the nation. (43)
With laboratory facilities secured and the support of their supervisor, Kendrick and Eldering turned their attention to forging solid, mutually beneficial working relationships with area physicians. Local doctors provided Kendrick and Eldering with cough plates from which the scientists could isolate the organism B. pertussis. At this time, there were no 'off-the-shelf' diagnostic plates. Culturing the pertussis bacillus was a 'tedious and expensive process.' In order to prevent hardier organisms with far-less-exacting growth medium and temperature requirements from overrunning the tiny pertussis colonies on the cough plates, scientists had to check the plates several times over a two-day period. (44) By modifying the then-standard Bordet-Gengou medium, Kendrick and Eldering produced a medium that fostered the rapid and profuse growth of B. pertussis colonies and could therefore be used as a routine diagnostic tool. (45) On November 1, 1932, Kendrick's laboratory began offering a cough-plate diagnostic service to area physicians.
Kendrick and Eldering also collaborated with the Grand Rapids Health Department. A. H. Edwards, who held the office of City Physician, notified them of pertussis infections in Grand Rapids; Kendrick and Eldering then went out into the community to collect samples. Many of the households they visited had been hit by the area's economic downturn; Grace Eldering noted in an interview that they learned 'about pertussis and the depression at the same time.' (46) When determining the average length of a whooping-cough infection required more samples than doctors' offices and the women's own forays into the community could provide, they were able to tap into the city's health network. The Great Depression had left Grand Rapids's furniture and other industries in a state of virtual collapse. As part of the effort to ensure that the city's residents had work, food, shelter, and health care, Grand Rapids City Manager George Welsh worked closely with the city commission to create a safety net where the city's health department provided clinics and home visits from city nurses. (47) Starting in 1930 the city engaged the services of the Grand Rapids Visiting Nurse Association (VNA), a private organization dedicated to the principle that 'no human being shall suffer or die neglected in any nook or corner of Grand Rapids,' to meet the increased medical needs of the city's poor. (48) The city's partnership with the VNA provided Kendrick and Eldering with a network of nurses who could rush exposed cough plates to their laboratory. From this cooperative effort, Kendrick and Eldering discovered that during the first three weeks of infection children's coughs contained a sufficient quantity of active pertussis bacilli to infect their peers; that most children were noninfectious by week four; and that after five weeks, 90 percent posed no risk to others. (49)
Kendrick and Eldering's cough-plate studies settled a debate raging in the public health community: what was the proper quarantine period for a child with whooping cough? Standards were inconsistent within Michigan and across state boundaries. The Grand Rapids Public Schools and the Grand Rapids Department of Health required that a child with whooping cough (and the child's siblings) be excluded from school for four weeks after the onset of the disease; a written permit was then required for the child to return to school. (50) In 1933 the State of Michigan required only a three-week isolation period. Around the lake, Chicago mandated a two-week quarantine followed by a three-week period in which the child could, with an attendant, walk on the streets while wearing a yellow armband with the words 'whooping cough' written on it in black letters. (51) The Grand Rapids Health Department adopted Kendrick and Eldering's quarantine findings; it required physicians to report the disease, ordered the department to place warning placards on homes, and enforced a thirty-five-day isolation period or, with two consecutive negative cough plates, a release after the twenty-eighth day. (52) As Pearl Kendrick noted in 1934, these 'regulations have crystallized out of our bacteriological studies and are now under test as part of the Grand Rapids Communicable Disease Regulations.' (53) In August 1934 A. H. Edwards remarked that 'through the cooperation of Dr. Pearl L. Kendrick of the Branch State Laboratory, the Health Division has been able to further whooping cough control by means of early diagnosis through cough plates. An effort is being made to establish the termination of infection by release plates.' (54) In the report of the Bureau of Laboratories, Cy Young added that 'the close association between the Western Michigan Department [of the Bureau of Laboratories] and the health work of the city makes a particularly advantageous arrangement for all concerned. The possibilities for cooperative investigation of health control measures [are] unlimited.' (55)
To comply with city regulations, physicians in Grand Rapids increasingly availed themselves of the state laboratory's diagnostic cough-plate service. When a physician requested help, the city's health department would dispatch a district nurse to secure a diagnostic cough plate, the results of which would be reported to both the physician and the department. (56) Although only twenty-two physicians participated the first year the service was offered, seventy physicians used the laboratory service during the second. (57) In 1935 Kendrick reported that the 'cough plate technic [sic] has become a routine procedure in the laboratory, accepted by the Grand Rapids Health Department as an aid to diagnosis and under study as a basis for release.' That same year, the Western Michigan Division performed 4,515 whooping-cough exams. (58)
Throughout their diagnostic studies, Kendrick and Eldering pursued their chief aim: an effective, safe, inexpensive, and easily produced pertussis vaccine. Early in 1933 Kendrick's laboratory began supplying pertussis vaccine to Leon DeVel, a local doctor who was the vice president of the Ann Arbor Pediatrics Society. (59) The children of a local pediatrician received the first doses of this vaccine. Vaccine production continued on a small scale in order to supply other area physicians who wanted to immunize their patients. (60) As doctors began requesting the vaccine, Kendrick appealed to Cy Young for permission to develop a more general vaccine: 'Rather than handl[ing] each request on the basis of an autogenous vaccine,' Kendrick explained, 'we can more efficiently make a supply from several local pertussis strains.' She then asked, 'May we do this on an experimental basis--supplying these few pediatricians who are the type to cooperate as to records?' (61) Young supported and applauded her efforts: 'Go ahead and do all you can with pertussis if it amuses you,' he wrote, knowing that they would be doing the work on their own time. (62)
With Young's permission, Kendrick and Eldering performed their carefully controlled animal studies of potential vaccines in a sterile room, a glassed-in cubicle located in the center of the serology laboratory. Using the general methods of Sauer and Hambrecht, the two scientists created a vaccine that was not only safer but also more potent. Kendrick and Eldering inactivated the pertussis bacilli with Merthiolate at cold room temperature for a week or more, and then they put the vaccine through numerous sterility and safety tests (including injecting the vaccine into their own arms). (63) Once declared safe, these vaccines were distributed to local physicians like DeVel. In return for the serum, he supported Kendrick and Eldering's laboratory work by spreading news of the vaccine to the medical personnel at Saint Mary's Hospital and other facilities and encouraging wider use of diagnostic cough plates. (64) DeVel would later assist at the vaccine-distribution clinics for the larger-scale studies that began in 1934.
Recruiting subjects for an extensive vaccine trial required community outreach; to this end, Kendrick and Eldering sought visibility for their work as an integral part of local efforts in public health. (65) They addressed a wide range of audiences in the city, including the staff at Butterworth Hospital, Saint Mary's Hospital, and the Sunshine Sanitarium. In addition, they spoke to the medical societies (and auxiliaries) of Kent and Ottawa counties; city, county, and private nurses; as well as local Parent Teacher Associations, business groups, and school groups. (66) Kendrick's November 1934 address to the General Federation of Women's Clubs on 'The March of Preventive Medicine in Grand Rapids,' which explored progress made in bacteriology and immunology, offers but one example of the scientists' community-outreach efforts. (67) In addition, Kendrick and Eldering cooperated with the city's health department on an exhibit on whooping-cough control for the Michigan State Medical Association and participated in the Michigan Department of Health's Education Department's public health programs. (68) These outreach efforts translated into local funding for their research and parents' willingness to enroll their children in the vaccine trials. For example, Dr. L. J. Schermerhorn, who would assist with the research and vaccine clinics, helped convince Ed Lowe, a local businessman and philanthropist, to donate $250 to aid Kendrick and Eldering's research. (69)
In February 1935 the Kent County Welfare Relief Commission decided to fund an immunization survey in Grand Rapids to aid the pertussis research and employ those in need of work. The survey's objective was to collect data on the prevalence of diphtheria, whooping cough, and smallpox among children in Grand Rapids; the number of preschool children immunized against diphtheria; the number vaccinated against smallpox; and the number who had received treatment to prevent whooping cough. (70) This survey illustrates Kendrick and Eldering's influence in Grand Rapids in several ways. First, earlier city-immunization surveys had focused only on smallpox and diphtheria. Second, the city's health department increasingly became involved in the pertussis research. The City Physician, A. H. Edwards, ran the survey and made the services of the city nurses available to the pertussis researchers. (71) As J. Benjamin Verhoek, project engineer in charge of the relief workers involved in the immunization survey, reported to James Granum at the State Emergency Relief Administration (SERA), 'the whooping cough data will be of definite value to Dr. Kendrick of the Branch State Laboratory in the study of whooping cough now being carried on under her direction.' (72) For this effort, SERA approved the project and budgeted $5,288 of Federal Emergency Relief Administration (FERA) money to staff the study with canvassers, typists, and timekeepers who would work with local volunteers and the Parent Teacher Associations. In March 1935, in support of this effort, the city commission contributed nearly $73 from the city's welfare fund to print forms for the immunization survey. (73) The Community Health Service, the City Health Department, the Kent County Medical Society, the Grand Rapids Council of Parent Teacher Associations, the Board of Education, the Grand Rapids Association of Commerce, and the Grand Rapids League of Women Voters all supported the survey with publicity and outreach to parents. (74) This preschool immunization study, completed in July 1935, and the careful records of the city health department's eighteen nursing districts provided Kendrick and Eldering with a means of selecting the controls (matched for age, sex, and district) that would help determine the effectiveness of their pertussis vaccine in field trials. (75)
In a 1958 retrospective on their field studies, Grace Eldering noted that 'among the many who contributed to the success of the program were the parents and their children who accepted the requirements for test and control groups in the field trials. This acceptance was basic, and laid a foundation in the community upon which other studies could be built.' (76) In the 1930s there were no accepted standards and few established models for conducting field studies. In 1933 Eleanor Roosevelt herself had begun investigating claims that orphans were being used in vaccine research. (77) Many vaccine and disease studies in the early twentieth century used orphans or institutionalized children for research subjects, as some researchers believed that these children were repaying a debt to society by participating in such experiments. The Grand Rapids researchers refused to rely on these vulnerable populations. Instead, they depended on the outreach networks they had built in the early stages of their research.
Many of the children in the Grand Rapids studies, due to the Depression's high unemployment rates, were receiving city aid and therefore were visited by city physicians and nurses. (78) Private physicians joined school physicians and city health officers in administering vaccines at the immunization clinics held in various primary schools, federally funded nursery schools, and at city hall, including Drs. DeVel, Schermerhorn, Ward L. Chadwick, T. D. Gordon, A. M. Hill, and Faith Hardy. (79) The children received a series of four or five shots. The city's public health nurses followed up at intervals of three to four months, checking patients for the bacillus with cough-plate findings, and, as needed, obtaining case histories for exposures and illnesses. (80) Speaking before the American Public Health Association (APHA) in 1936, Kendrick noted that they could not 'praise too highly' the Bureau of Public Health Nursing's outreach and follow-up work. School Superintendent Leslie A. Butler also got in on the act, lauding the fine cooperation between the city's health authorities and the health department's medical and nursing staff and the schools. (81)
From 1933 through February 1935, Kendrick and Eldering's total budget for their research was $1,250; they received this funding from the city commission, Ed Lowe, and the National Research Council. A grant of $1,800 from the FERA project funded their research from February through August 1935. In August 1935 Pearl Kendrick successfully appealed to the Grand Rapids City Commission for aid in closing a small but critical funding gap. Kendrick noted that while 'the results with whooping cough vaccine to date are most encouraging,' the research was at a critical juncture and the project needed to continue uninterrupted. Many children around the city were suffering from whooping cough, and disrupting the vaccine schedule would leave children in the study only partially protected and interrupt regular visits by the nurses who provided information on exposures and disease. Kendrick warned that 'to have this information of the greatest value, it must be obtained regularly and an interruption of the project would seriously interfere.' (82) She urged the city commission to take part 'in a progressive public health project in our city' by providing $300 to help cover the three to four weeks of research between the close of the FERA project and the start date of a Works Progress Administration (WPA) grant. (83) The city commission viewed Kendrick and Eldering's work as % state or national project [that] should be supported accordingly,' and it voted to contribute $200 from the contingent fund. However the commission also decided that no more funds would be supplied for the research. (84)
When City Physician A. H. Edwards, an important supporter of the pertussis research, died in 1935, the citizens of Grand Rapids sought to find a replacement who would, in the words of the Grand Rapids Association of Commerce's health committee chair, Dr. R. H. Denham, 'possess the standard qualifications for health officers in cities of the size of Grand Rapids,' specifically % degree of Doctor of Public Health in addition to an M.D. degree, with experience in public health administration.' (85) The Grand Rapids Federation of Women's Clubs noted in 1935 that Grand Rapids held an ''enviable position' in the cities of the United States as to its health record, ... a record which has only been possible through the perfect coordination of its various health units; namely, health officers, health agencies, and the members of the medical profession. This most splendid record, we wish to uphold.' The women's clubs and the executive board of the Grand Rapids Council of Parent Teacher Associations pressed for someone to be hired full time in order that this person could secure the federal aid given to cities 'where a full time officer is employed.' (86) They were pleased when, on November 14, 1935, the city commission appointed John L. Lavan, a Grand Rapids native and a former health officer for Kalamazoo, to replace Edwards. (87) The Grand Rapids Herald praised Lavan's appointment, noting that he had no political alliances that would allow politics to prevail over the city's needs and that he was experienced in public health, which would aid the city in procuring federal funds. Furthermore, his Grand Rapids origins meant that he would champion the city's interests. The Herald also used the appointment as an opportunity to recognize Grand Rapids's many innovations in public health, noting that the River City should congratulate itself 'upon the prospect of a continuance of the excellent service and progress we have always maintained along public health lines.' (88) The praise for Lavan was part of a larger middle-class reform movement that sought to oust ward-based machine politicians and install reformers who would aid the city as a whole. (89) Like his predecessor, Lavan supported the research and field testing of Kendrick and Eldering's vaccine and a range of other projects related to improving the health of the city's residents. (90)
The 1934 to 1936 field trial involved almost 1600 children (712 vaccinated and 880 controls matched for age, district, and sex). In 1936 Kendrick and Eldering published their vaccine results in the American Journal of Public Health. Although they cautioned against the 'danger of giving [the numbers] too much weight in the face of the relatively small number of whooping cough cases,' their results were dramatic. Only 4 of the 712 vaccinated children suffered from whooping cough, and they had mild cases, while 45 of the 880 unvaccinated controls contracted the disease and suffered its full ravages. (91)
Although it was well controlled, the 1934-1936 field trial had to surmount considerable initial skepticism within the national public health community. (92) Shortly after Kendrick and Eldering announced their results, James Doull, a prominent Cleveland epidemiologist, reported that children received no protection from a vaccine he had designed and produced. The APHA subcommittee on whooping cough, which included both Kendrick and Doull, evaluated the contradictory results of the two studies but was unable to explain why they differed. The committee then asked Wade Hampton Frost, a Johns Hopkins epidemiologist and the head of the APHA, to review both studies. (93)
Frost was predisposed to find fault with Kendrick's study. In a 'personal' note on September 10, 1936, to George H. Ramsey, Director of the Division of Communicable Disease of the New York State Health Department, Frost voiced his doubts: 'I very strongly suspect that Miss Kendrick's field studies are not set up in such a way as to give a really good control. My reason for this suspicion is that, as you know well enough, the satisfactory set-up of such an experiment is an exceedingly difficult matter. Not 1 out of 10--perhaps not 1 out of 50--attempts is successful and as a mere matter of probability the odds are strongly against Miss Kendrick's experiments being sound.' (94)
Unable to find the faults he expected in Kendrick and Eldering's study, Frost journeyed twice to Grand Rapids to examine their data and recommend suggestions for improving statistical accuracy and coding. In the end, Frost said to Kendrick, 'I think it may be assumed, not as a conclusion but merely as a working hypothesis, that your data when finally analyzed are likely to show some protection in the vaccinated group. Therefore, without accepting this as a conclusion, I think it is proper to make plans for further work based on this presumption, and I would suggest two additional projects.' (95)
When the whooping-cough vaccine project's funds again ran low, Kendrick invited Eleanor Roosevelt to visit the laboratory. The First Lady spent thirteen hours in Grand Rapids on March 9, 1936, a schedule that one reporter noted would 'make a debutante wan and through it all [Roosevelt] remained smiling, affable and gracious.' (96) The Western Michigan Branch Laboratory was one of her many stops. Paul De Kruif, author of the Microbe Hunters and a champion of Kendrick and Eldering's project who would later praise their pertussis research as 'one of the greatest field tests in microbe-hunting history,' (97) pleaded with Mrs. Roosevelt to expand funding of the program to $50,000 a year from the $7,000 a year it was then receiving. He noted that 'by one project like this, convincing the plain American citizen ... that his baby needn't die of whooping cough, you could sell them on the whole WPA. One such project would answer the objections made to boondoggling.' (98) Although the requested $50,000 was not forthcoming, Roosevelt helped secure the money needed to add several WPA workers to Kendrick and Eldering's staff. (99) In June 1936 Kendrick requested additional personnel (one bacteriologist and a half-time laboratory assistant) from the state to increase the vaccine yield. (100) In November 1937 Kendrick wrote to Young about staffing problems. When hiring Marian Sprick as a serologist resulted in the loss of a pertussis-immunization bacteriologist, Kendrick sought additional WPA funds to hire a replacement to fill that position, noting to Young that 'I do hope they may be willing to do this so we can take up again the bacteriology related to the immunization project.' (101) The state laboratory, drawing on federal funds that were increasingly becoming available, would also expand its hiring to aid in the pertussis research. (102) In 1938 the WPA furnished additional clerical staff, and the APHA helped defray the cost of statistical analysis. (103) By 1942 Kendrick and Eldering had received a total of $181,695 for their research, much of it from large federal and state grants. (104)
Encouraged by the vaccine trial's results, Grand Rapids parents flocked to enlist their children in the study; by 1939, Kendrick and Eldering had enrolled more than four thousand children. The vaccine would soon gain acceptance far beyond Grand Rapids. The Biological Products Division, which was part of the state's health department, began producing the vaccine for Michigan children in 1938. By 1940 the state's pertussis vaccine was being distributed across the nation. In 1943 the American Academy of Pediatrics approved the vaccine for routine use; a year later, the American Medical Association recommended immunization. (105) Michigan's, and indeed the nation's, whooping-cough incidence and mortality would drop dramatically. After 1948 there were fewer than thirty pertussis deaths a year in Michigan. (106) In 1934 the whooping-cough incidence in the United States was 209 cases per 100,000 residents, and the death rate was 5.9 per 100,000. In 1948 the incidence had dropped to 51 cases per 100,000 people, and the death rate had dropped to fewer than 1 per 100,000. After 1960 the incidence was fewer than 10 cases per 100,000. (107)
Kendrick and Eldering continued their studies of pertussis by standardizing vaccine density (an effort coordinated with the National Institutes of Health), exploring the value of multiple-antigen vaccines (for example, a combined DPT vaccine), and researching methods for measuring relative vaccine potency, including a mouse-protection assay. (108) Grand Rapids and Michigan's Department of Health rewarded Kendrick and Eldering's successful research efforts with improved laboratory facilities and expanded staffing. Much of their later work would take place in a new laboratory in Grand Rapids that they helped George Cummings, the Director of Laboratories, to design. This facility opened in the 1950s. (109) Eldering took charge of the laboratory in 1951, but Kendrick, now an assistant professor of public health in Ann Arbor, maintained her ties with the Grand Rapids community.
Kendrick and Eldering were recognized nationally and internationally as leaders in the fight against whooping cough. Later, Kendrick chaired the APHA's committee on whooping cough. (110) In their 1946 Textbook of Bacteriology, Edwin O. Jordan and William Burrows cited Kendrick and Eldering's 1939 and 1943 research articles to support their claim that 'it is now definitely established that active immunization with properly prepared vaccine confers an effective immunity to pertussis.' (111)
Grand Rapids also received recognition for its efforts in the field trials. The city entered and consistently achieved high honors in the Healthiest City contests sponsored by the APHA and the InterChamber Health Division of the Chamber of Commerce of the United States beginning in 1930. These achievements, City Physician Edwards explained, were 'due [not only] to our thoroughness in conducting our work, but also [to] the cooperation between the medical profession and the lay agencies in our city.' (112) In its annual contest applications, the city consistently highlighted the pertussis research being done in Grand Rapids. In 1939 Grand Rapids won first place in both the APHA and the chamber of commerce contests for cities with a population between 100,000 and 250,000. (113)
In the years that followed, Kendrick and Eldering willingly shared their knowledge with the international public health community. The pages of their passports and their membership cards from professional societies reveal their regular participation on the international conference circuit. (114) Kendrick traveled the world helping to establish vaccine programs in Great Britain, Mexico, Eastern Europe, and Central and South America, often as a consultant for the World Health Organization. In 1962 Kendrick served as part of an exchange delegation on immunology to the Soviet Union. (115) Kendrick and Eldering were intimately involved in the inner circles of the international bacteriology and public health communities. Local, national, and international scientists related stories of the women's gracious hospitality at dinner parties and picnics they hosted at their home in Grand Rapids. (116) In 1971 Kenneth W. Cochran of the University of Michigan noted that some years ago the university had conferred emerita status on Kendrick, however 'as far as anyone can tell ... she has yet to retire.' He then noted that 'not the least of her contributions to the School of Public Health was the aura at once of public achievement and of personal distinction and grace which she brought to every office.' (117)
Kendrick and Eldering never lost sight of the significant support they had received from Michigan's Department of Health, Grand Rapids, and local civic organizations. They continued to believe that scientific progress would bring safer and better vaccines and that only communitywide efforts could produce such successes. In a 1975 interview with the Grand Rapids Press, Kendrick noted that 'it just seemed that while we were giving children protection from various diseases, we were also adding more and more injections. It seemed possible to combine them, to save the poor children all that discomfort.' (118) They did more than save children discomfort; Kendrick, Eldering, and the people of Grand Rapids made a safer childhood possible--one wherein children could grow to adulthood untouched by the ravages of whooping cough and other childhood diseases. As Grace Eldering stated in her 1958 retrospective on the field trials: 'Perhaps the most interesting fact was the demonstration of what can be accomplished by a whole community working together.' (119)
The author would like to thank Eric Shapin, Susan Stein-Roggenbuck, Kathleen Underwood, and the two anonymous reviewers for comments and suggestions. In addition, thanks are due to the archivists from the Bentley Historical Library, the Grand Rapids Public Library's Special Collections, the Grand Rapids City Archives, the Library of Michigan, the American Institute for the History of Pharmacy Archives, and the Grand Rapids Visiting Nurse Association.
(1) C. B. Burr, Medical History of Michigan (Minneapolis: Bruce Publishing, 1930), 827.
(2) Louis W. Sauer, 'Whooping Cough: Resume of Seven Years' Study,' Journal of Pediatrics 2 (June 1933): 740-49.
(3) In 1932, 13,000 Michigan children contracted the disease and 199 died. 'Report of the Bureau of Records and Statistics,' 60th Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1932 (Lansing: Franklin DeKleine, 1933), 132; 'Report of the Bureau of Records and Statistics,' 61st Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1933 (Lansing: Franklin DeKleine, 1934), 556, 666. These reports are based on administrative years (July to June).
(4) Richard Meckel, 'Save the Babies' American Public Health Reform and the Prevention of Infant Mortality, 1850-1929 (Baltimore: Johns Hopkins University Press, 1990), 102-3.
(5) For example, see Evelynn Maxine Hammonds, Childhood's Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880-1930 (Baltimore: Johns Hopkins University Press, 1999); Smart Galishoff, Safeguarding the Public Health: Newark, 1895-1918 (Westport, Conn.: Greenwood Press, 1975); Judith Walzer Leavitt, The Healthiest City: Milwaukee and the Politics of Health Reform (Princeton, N.J.: Princeton University Press, 1982); Barbara Gutmann Rosenkrantz, Public Health and the State.' Changing Views in Massachusetts, 1842-1936 (Cambridge: Harvard University Press, 1972); Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge: Harvard University Press, 1998); Alan M. Kraut, Silent Travelers: Germs, Genes, and the 'Immigrant Menace' (New York: Basic Books, 1994); and John Duffy, The Sanitarians: A History of American Public Health (Urbana: University of Illinois Press, 1990).
(6) By the time Kendrick and Eldering produced their whooping-cough vaccine, the international community was well-acquainted with the protective power of vaccination, although there were still debates surrounding state vaccine requirements. For example, see Anne Hardy, ''Straight Back to Barbarism': Antityphoid Inoculation and the Great War, 1914,' Bulletin of the History of Medicine 74 (Summer 2000): 265-90; Vincent J. Cirillo, Bullets and Bacilli: The Spanish-American War and Military Medicine (New Brunswick, N.J.: Rutgers University Press, 2004); Hammonds, Childhood's Deadly Scourge; and James Colgrove, ''Science in a Democracy': The Contested Status of Vaccination in the Progressive Era and the 1920s,' Isis 96, no. 2 (2005): 167-91. On the consequences of the uncertainties of the new bacteriological findings, see James C. Mohr, Plague and Fire: Battling Black Death and the 1900 Burning of Honolulu's Chinatown (New York: Oxford University Press, 2004); Patricia Peck Gossel, 'A Need for Standard Methods: The Case of American Bacteriology,' in The Right Tools for the Job: At Work in Twentieth-Century Life Sciences, ed. Adele E. Clarke and Joan H. Fujimura (Princeton, N.J.: Princeton University Press, 1992), 287-311; and J. Rosser Matthews, 'Major Greenwood versus Almroth Wright: Contrasting Visions of 'Scientific' Medicine in Edwardian Britain,' Bulletin of the History of Medicine 69 (Spring 1995): 30-43. On clinical trials, see Ted J. Kaptchuk, 'Intentional Ignorance: A History of Blind Assessment and Placebo Controls in Medicine,' Bulletin of the History of Medicine 72 (Summer 1998): 389-433; and Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (New York: Cambridge University Press, 1997).
(7) On federal funding of health care and research during the Depression, see Michael R. Grey, New Deal Medicine: The Rural Health Programs of the Farm Security Administration (Baltimore: Johns Hopkins University Press, 1999); and A. Hunter Dupree, Sconce in the Federal Government: A History of Policies and Activities (1957; repr., Baltimore: Johns Hopkins University Press, 1986).
(8) Grace Eldering, 'Symposium on Pertussis Immunization, in Honor of Dr. Pearl L. Kendrick in her Eightieth Year: Historical Notes on Pertussis Immunization,' Health Laboratory Science 8 (October 1971): 210-14, gives an 'autobiographical' account of the experiments. Other scientists' accounts are found in William E. Bunney et al., 'History of the Antigen Committees of the American Public Health Association,' American Journal of Public Health 55 (September 1965): 1451-59; and Margaret Pittman, 'History of the Development of Pertussis Vaccine,' Developments in Biological Standardization 73 (1991): 13-32. Historians' and clinicians' accounts include H. J. Parish, Victory with Vaccines: The Story of Immunization (Edinburgh: E. & S. Livingstone, 1968); David Geier and Mark Geier, 'A True Story of Pertussis Vaccination: A Sordid Legacy?' Journal of the History of Medicine and Allied Sciences 57 (July 2002): 249-84; and Jeffrey P. Baker, 'Immunization and the American Way: 4 Childhood Vaccines,' American Journal of Public Health 90 (February 2000): 199-207. There are also several popular accounts including Paul De Kruif, 'We Can Wipe out Whooping Cough,' Reader's Digest, January 1943, 125. On the role of local forces in promoting scientific innovation, see Jennifer Stanton, ed., Innovations in Health and Medicine: Diffusion and Resistance in the Twentieth Century (New York: Routledge, 2002).
(9) Alumni Association Booklet for Sherburne Union School, 1924, Biographical and Genealogical folder, box 1, Pearl Kendrick Papers (hereafter Kendrick Papers), Bentley Historical Library, Ann Arbor, Mich.; Steve Grinczel, 'Dr. Grace,' Grand Rapids Press, October 10, 1984, B1-2.
(10) Margaret W. Rossiter, Women Scientists in America: Before Affirmative Action, 19401972 (Baltimore: Johns Hopkins University Press, 1995), 277.
(11) Rosenkrantz, Public Health and the State, 97-127.
(12) Recommendation from Richard R. Blews, President of Evansville Junior College, Evansville, Wis., April 3, 1914, Employment folder, Letters of Recommendation, 19141919, box 1, Kendrick Papers.
(13) Recommendation from John R. Palmer, Supervising Principal of Saint Johnsville Public Schools, Saint Johnsville, N.Y., February 26, 1918, in ibid.
(14) Margaret W. Rossiter, Women Scientists in America.' Struggles and Strategies to 1940 (Baltimore: Johns Hopkins University Press, 1982), 242-43.
(15) C. C. Young to Pearl L. Kendrick, March 27, 1920, Michigan Department of Health-Employment 1920-1952 folder, box 3, Kendrick Papers.
(16) Kendrick's handwritten notes; Kendrick to Young, March 30, 1920, both in ibid.
(17) William H. Park to Pearl L. Kendrick, June 28, 1923, Employment: New York State Department of Health folder, box 1, Kendrick Papers.
(18) Richard Harms, 'Grace Eldering Developed the Vaccine,' Grand Rapids Magazine, March 1994, 37; Grinczel, 'Dr. Grace'; Shirley Redland (Eldering's niece), telephone interview by author, November 11, 1999.
(19) 48th Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1920 (Lansing: Wynkoop, Hallenbeck, Crawford, 1921), 9. Herman Biggs's words were originally published in the October 1911 edition of the New York City Health Department's Monthly Bulletin. Biggs ran the New York City Health Department from 1902 to 1913 and served as New York State's Commissioner of Public Health from 1914 to 1923. Rosenkrantz, Public Health and the State, 5.
(20) 51st Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1923 (Fort Wayne, Ind.: Fort Wayne Printing, 1923), 44.
(21) Michigan quickly passed the enabling legislation needed to incorporate federal Sheppard-Towner funds into the state's existing mammal- and infant-hygiene programs. 49th and 50th Annual Reports of the Commissioner of the Michigan Department of Health for the Fiscal Years Ending June 30, 1921, and June 30, 1922 (Fort Wayne, Ind.: Fort Wayne Printing, 1922), 11. On the activities of the Michigan Department of Health, see Carolyn G. Shapiro-Shapin, 'Public Health Is Public Wealth: The Shifting Gaze of the Michigan Department of Health, 1920-1940,' delivered at the Great Lakes History Conference, Grand Rapids, Mich., October 21, 2006; and Annual Reports of the Commissioner of the Michigan Department of Health for the years 1919 to 1944.
(22) 51st Annual Report ... Ending June 30, 1923, 9.
(23) 58th Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1930 (Lansing: Franklin DeKleine, 1932), 8-9; 59th Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1931 (Lansing: Franklin DeKlcine, 1932), 22.
(24) Shapiro-Shapin, 'Public Health Is Public Wealth.' The research agenda would include studies of syphilis detection (Kahn Test), goiter, and whooping cough.
(25) Biographical data form for Who's Who of American Women, Biographical and Genealogical folder, box 1, Kendrick Papers.
(26) 'Bureau of Laboratories Report,' 58th Annual Report ... Ending June 30, 1930, 85.
(27) Elizabeth Fee, Disease and Discover: A History of the Johns Hopkins School of Hygiene and Public Health, 1916-1939 (Baltimore: Johns Hopkins University Press, 1987).
(28) 'Bureau of Laboratories Report,' 58th Annual Report ... Ending June 30, 1930, 83.
(29) 59th Annual Report ... Ending June 30, 1931, 457.
(30) Rossiter, Women Scientists in America: Struggles and Strategies, 243.
(31) Grinczel, 'Dr. Grace.' Kendrick and Eldering shared a home on the northeast side of Grand Rapids. Dr. Lucille Portwood, interview by author, August 28, 2000, East Lansing, Mich.; Loney Clinton Gordon, interview by author, March 19, 1998, East Lansing, Mich.; Margaret Day (Eldering's caretaker in her later years), interview by author, September 28, 1999, Grand Rapids, Mich.; Redland, interview, November 11, 1999.
(32) J. Bordet and O. Gengou, 'Le Microbe de la Coqueluche,' Annales de l'Institut Pasteur 20 (September 1906): 731-41.
(33) C38(a) I Abbott File, 1925-1930; C38(a) Eli Lilly folder; and C38(a) I SwanMyers file, all in Kremers Reference Files, American Institute for the History of Pharmacy Archives (hereafter AIHP), Madison, Wis. According to the Mulford literature, the mixed vaccine not only would protect against pertussis but also would prevent and treat the secondary infections that accompanied the disease. 'Pertussis Bacterin Mixed and Pertussis Serobacterin Mixed,' Mulford Working Bulletin 19 (1913): 2-3; Practical Notes on Serobacterin, Bacterin, and Serum Therapy, 19th ed. (Philadelphia: H. K. Mulford, 1927), 9; C38(a) I Mulford, H. K., 1923-1929 folder; Eli Lilly and Company, Handbook of Pharmacy and Therapeutics (Indianapolis, Ind.: Eli Lilly, 1925), 221, all in Kremers Reference Files, AIHP.
(34) Council on Pharmacy and Chemistry, 'Pertussis Vaccines Omitted from N. N. R.,' Journal of the American Medical Association 96 (February 1931): 613.
(35) T. Madsen, 'Vaccination against Whooping Cough,' Journal of the American Medical Association 101 (July 1933): 187-88; Parish, Victory with Vaccines.
(36) P. H. Leslie and A. D. Gardner, 'The Phases of Haemophilus Pertussis,' Journal of Hygiene 31 (July 1931): 423-34.
(37) Sauer, 'Whooping Cough,' 748.
(38) Charlotte H. Singer-Brooks, 'Pertussis Prophylaxis--A Controlled Study' (master's thesis, University, of Michigan, 1940), 1-7. Pharmaceutical companies worked closely with both academic scientists and the public health community to develop, produce, and distribute vaccines. See John P. Swann, Academic Scientists and the Pharmaceutical Industry: Cooperative Research in Twentieth-Century America (Baltimore: Johns Hopkins University Press, 1988); Louis Galambos and Jane Eliot Sewell, Networks of Innovation: Vaccine Development at Merck, Sharp & Dohme, and Mulford, 1895-1995 (New York: Cambridge University Press, 1995); John Parascandola, The Development of American Pharmacology: John J. Abel and the Shaping of a Discipline (Baltimore: Johns Hopkins University Press, 1992); Gregory J. Higby and Elaine C. Stroud, eds., The Inside Story of Medicines: A Symposium (Madison, Wis.: American Institute of the History of Pharmacy, 1997); and Ramunas A. Kondratas, 'Biologic Control Act of 1902,' in The Early Years of Federal Food and Drug Control, ed. James H. Young (Madison, Wis.: American Institute of the History of Pharmacy, 1982), 8-27.
(39) Z. Z. Lydens, ed., The Story of Grand Rapids (Grand Rapids: Kregel Publications, 1966), 568-69. In 1917 the board of health expanded the position of C. C. Slemons, the city's first health officer, into a full-time appointment with a yearly salary of $4,000. Slemons was the State Commissioner of Health from 1930 to 1941, and then he returned to Grand Rapids to serve as the city's health commissioner until 1952. On city boards of health, see Duffy, Sanitarians, 138-56.
(40) 49th and 50th Annual Reports ... Ending June 30, 1921, and, June 30, 1922, 140.
(41) 'Seek Parents' Aid in School Health,' Grand Rapids Press, February 2, 1921, 15; Ottawa Hills Elementary P. T. A. Collection, #60, folder 2, box 1, Grand Rapids Public Library Special Collections (hereafter GRPLSC); Lydens, ed., Story of Grand Rapids, 569.
(42) 58th Annual Report ... Ending June 30, 1930, 20.
(43) Ellen Arlinsky and Marg Ed Kwapil, In Celebration of Grand Rapids (Northridge, Calif.: Windsor Publications, 1987), 323; Michigan Department of Health, Michigan Department of Health: The First Hundred Years (n.p.: Michigan Department of Health, 1973), 87-89.
(44) Pearl Kendrick and Grace Eldering, 'Cough Plate Examinations for B. pertussis,' American Journal of Public Health 24 (April 1934): 309-18. Loney Gordon, a scientist who worked in Kendrick's laboratory in the 1940s, noted, 'The morphology that you wanted was a pearl-like colony growing on this red plate with this clear halo around it ... the organism had used up the blood around it and it looked like a little pearl sitting on the medium.' She then added that after looking at thousands of plates, 'it's a wonder I still have eyes.' Gordon, interview, March 19, 1998.
(45) Eldering, 'Symposium,' 202.
(46) Ibid., 200.
(47) The city's solution for the problems of unemployment and poverty came in the form of a controversial city-financed public-relief project that President Roosevelt would hold up as a model for his New Deal programs. Although unemployment did not disappear, of course, Grand Rapids gained a reputation as 'the city where every man has a job.' Gerald Elliot, Grand Rapids: Renaissance on the Grand (Tulsa, Okla.: Continental Heritage Press, 1982), 116, 118-28.
(48) Lydens, ed., Story of Grand Rapids, 396. Started in 1893 as the Charity Organization Society, the parent organization hired one visiting nurse, paid for and supplied by voluntary donations. In 1908 the District Nurse Association separated from the Charity Organization Society, and in 1915 it changed its name to the Visiting Nurse Association. Board Minutes, April 8, 1931, Board Minutes, 1930s folder, box 11, Visiting Nurse Association Archives (hereafter VNA), Grand Rapids Visiting Nurse Association, Grand Rapids, Mich.
(49) Kendrick and Eldering, 'Cough Plate Examinations,' 310-11; Pearl Kendrick and Grace Eldering, 'Progress Report on Pertussis Immunization,' American Journal of Public Health 26 (January 1936): 8-12.
(50) The Control of Communicable Diseases among School Children: School Health Service, Bulletin I, Health Division, Department of Public Welfare, Grand Rapids, Mich., September 1933, folder 268a, box 14, Kent County Medical Records, GRPLSC.
(51) Henry L. K. Shaw, Infectious Diseases of Infancy and Childhood (New York: D. Appleton, 1928), 132; Hans Zinsser and Stanhope Bayne-Jones, A Textbook of Bacteriology, 7th ed. (New York: D. Appleton-Century, 1935), 414-15.
(52) 'Report of the Bureau of Laboratories,' 62nd Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1934 (Lansing: Franklin DeKleine, 1936), 129.
(53) Pearl Kendrick and Grace Eldering, 'Significance of Bacteriological Methods in the Diagnosis and Control of Whooping Cough,' American Journal of Public Health 25 (February 1935): 147-55, 149 (quotation, emphasis added).
(54) A. H. Edwards to C. E. Edwards, August 8, 1934, A. H. Edwards, Scrapbook, GRPLSC.
(55) 'Report of the Bureau of Laboratories,' 62nd Annual Report ... Ending June 30, 1934, 127.
(56) Kendrick and Eldering, 'Cough Plate Examinations,' 312; idem, 'Significance of Bacteriological Methods,' 148.
(57) 'Report,' 62nd Annual Report ... Ending June 30, 1934, 129.
(58) 'Report of the Bureau of Laboratories,' 63rd Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1935 (Lansing: Franklin DeKleine, 1937), 485, 490.
(59) Pearl Kendrick to C. C. Young, February 4, 1933, Correspondence-C. C. Young, 1926-1939, box 3, Kendrick Papers.
(60) Grace Eldering, 'Whooping Cough Studies in Grand Rapids and Kent County,' Journal of the Michigan State Medical Society 57 (February 1958): 221-24, 232.
(61) Kendrick to Young, February 4, 1933. Autogenous vaccines are created for an individual patient from the whooping-cough bacilli isolated from that patient's own cough plate.
(62) C. C. Young to Pearl Kendrick, February 21, 1933, Correspondence--C. C. Young, 1926-1939, box 3, Kendrick Papers.
(63) Eldering, 'Symposium,' 202; Pearl Kendrick to C. C. Young, March 30, 1933, Correspondence--C. C. Young, 1926-1939, box 3, Kendrick Papers. Such trials were not without risk; field tests of polio vaccines in 1935 had gone awry, leaving children paralyzed. David M. Oshinsky, Polio: An Amebean Stop (New York: Oxford University Press, 2005), 56-58.
(64) Kendrick to Young, February 4, 1933.
(65) The people of Grand Rapids were interested in proper food handling, water filtration, birth control, the health and welfare of the poor, and immunization. A. T. McFadyen to C. E. Edwards, August 23, 1934, A. H. Edwards, Scrapbook; Chamber of Commerce, Director's Minutes, vol. 18, August 12, 1936, Grand Rapids Association of Commerce, collection #46, box 37, both in GRPLSC.
(66) 'Report of the Bureau of Laboratories,' 63rd Annual Report ... Ending June 30, 1935, 496; 60th Annual Report ... Ending June 30, 1932, 107; 61st Annual Report ... Ending June 30, 1933, 530-31; 'Report,' 62nd Annual Report ... Ending June 30, 1934, 130-31. Although the Department of Health's Bureau of Education would pull back from offering more than one thousand lectures per year in the mid-1920s to a more modest number in the 1930s (between four hundred and six hundred), it continued to reach between thirty-two thousand and forty thousand individuals each year. In addition, the department filled thousands of requests for informational pamphlets and created materials for schools. See Annual Report of the Commissioner of the Michigan Department of Health for the years 1919 to 1940.
(67) Public Welfare Department Report, 1934-1935, General Federation of Women's Clubs Records, folder 8, box 2; Meeting Minutes, November 8, 1934, General Federation of Women's Clubs Records, folder 7, box 7, both in GRPLSC.
(68) 'Report,' 60th Annual Report ... Ending June 30, 1932, 46.
(69) Pearl Kendrick to L. J. Schermerhorn, May 1, 1935, Michigan Department of Health Correspondence, box 3, Kendrick Papers.
(70) Minutes, Kent County Health Department, December 6, 1934; March 25, 1935, both in Kent County Medical Records, folder 83, box 5, GRPLSC; C. Sophus Johnson to the Mayor and City Commission, March 21, 1935, no. 65088, City of Grand Rapids, City Commission Documents (hereafter GRCCD), Grand Rapids City Archives. Also see J. Benjamin Verhoek to James Granum, February 1, 1935, no. 65018, GRCCD. I am grateful to Susan Stein-Roggenbuck for insights into the relationships among the federal, state, and local welfare bureaucracies.
(71) This 1935 study was not the first immunization study in Grand Rapids. President Herbert Hoover invited Ada Coleman of the Grand Rapids Visiting Nurse Association to attend a White House conference on children's health, an invitation she declined because she was then engaged in an immunization study involving five hundred Grand Rapids families. Visiting Nurse Association, Board Minutes, November 12, 1930, 1930's folder, box 11, VNA.
(72) Verhoek to Granum, February 1, 1935.
(73) Johnson to the Mayor and City Commission, March 21, 1935. FERA spent a total of $1,568.60 of the $5,215 budgeted for the immunization survey in 1934 to 1935. Record of FERA Expenditures, 1934-1935, presented to the Grand Rapids City Commission, May 21, 1936, no. 67474, GRCCD.
(74) Verhoek to Granum, February 1, 1935; Landmarks in Pertussis Immunization Study, 1932-1935, Pertussis Studies folder, box 4, Kendrick Papers; School Health Survey Study, September 15, 1938, no. 72247, GRCCD.
(75) Michigan Department of Health, 'Whooping Cough Prevention Study,' October 22, 1936, Pertussis Studies folder, box 4, Kendrick Papers.
(76) Eldering, 'Whooping Cough Studies,' 224.
(77) Susan E. Lederer, Subjected to Science: Human Experimentation in America before the Second World War (Baltimore: Johns Hopkins University Press, 1995), 108.
(78) Kendrick and Eldering, 'Cough Plate Examinations,' 312.
(79) Kendrick and Eldering, 'Progress Report on Immunization,' 12; Pearl Kendrick and Grace Eldering, 'A Study in Active Immunization against Pertussis,' American Journal of Hygiene 29 (May 1939): 133-53.
(80) Kendrick and Eldering, 'Progress Report on Immunization,' 9.
(81) The Control of Communicable Diseases among School Children.
(82) Pearl Kendrick to the Grand Rapids City Commission, August 17, 1935, no. 66095, GRCCD.
(83) Ibid.
(84) Henry Walstrom and H. C. Leonard to the City Commission, August 23, 1935, no. 66134, GRCCD. The resolution to grant the $200 passed unanimously.
(85) R. H. Denham and Alex T. McFadyen to the Mayor and City Commission of Grand Rapids, October 10, 1935, no. 66416; F. Hugh Utley to the Mayor and City Commission of Grand Rapids, October 14, 1935, no. 66438, both in GRCCD.
(86) Clara G. Zwingeberg and Emily Chamberlain to the City Commission of Grand Rapids, October 14, 1935, no. 66438, GRCCD.
(87) Proceedings of the City Commission, November 14, 1935, 289, Grand Rapids City Archives; 'Lavan, Who Was Encouraged to Study by Elder Dr. Edwards, on Job,' Grand Rapids Herald, November 16, 1935, 4.
(88) 'Dr. Lavan,' Grand Rapids Herald, November 14, 1935, 6.
(89) On the reform movement in Grand Rapids, see Michael Cheyne, 'The Battle for Grand Rapids: Reform vs. Expediency in the 1940s Citizens Action Movement,' paper delivered at the Great Lakes History, Conference, Grand Rapids, Mich., October 21, 2006.
(90) Proceedings of the City Commission, December 26, 1935, 339, Grand Rapids City Archives.
(91) Kendrick and Eldering, 'Progress Report on Immunization,' 12.
(92) Bunney et al., 'History of the Antigen Committees.' Jeffrey Baker has pointed out that Kendrick's work was contested by American scientists and not readily accepted overseas either. Baker, 'Immunization and the American Way.'
(93) Fee, Disease and Discovery, 132-36. Widely regarded as the founder of the analytic base and methodological principles of epidemiology, Wade Hampton Frost was often called in as an expert to consult in ongoing field investigations.
(94) George H. Ramsey to W. H. Frost, August 27, 1936; W. H. Frost to George H. Ramsey, September 10, 1936, both in Pertussis Correspondence, Ramsey folder, box 3, Kendrick Papers. Frost added, 'Then ... I would think it necessary, before accepting a conclusion of this importance, to have a thorough check-up of her observations made on the ground. If you and Maxcy could do this it would be fine. You would do it better than I would and in case the findings should be unfavorable I would have somebody to share the odium with me.'
(95) W. H. Frost to Pearl L. Kendrick, September 21, 1937, Pertussis Plans II, Frost folder, box 4, Kendrick Papers.
(96) Marguerite S. Kearns, 'Smiling, Active First Lady Has Strenuous Visit Here,' Grand Rapids Herald, March 10, 1936, 1.
(97) De Kruif, 'We Can Wipe Out Whooping Cough.'
(98) Kearns, 'First Lady Has Strenuous Visit Here.'
(99) Rossiter, Women Scientists in America: Struggles and Strategies to 1940, 243.
(100) Pearl Kendrick to C. C. Young, June 27, 1936, Correspondence--C.C. Young, 1926-1939, box 3, Kendrick Papers.
(101) Pearl Kendrick to C. C. Young, November 30, 1937, in ibid.
(102) Shapiro-Shapin, 'Public Health Is Public Wealth.'
(103) 'Report of the Bureau of Laboratories,' 66th Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1938 (Lansing: Franklin DeKleine, 1940), 102.
(104) Michigan Department of Health, Estimate of Costs of Pertussis Studies, Pertussis Studies folder, box 4, Kendrick Papers. Using the Consumer Price Index, $181,700 in 1940 dollars would be worth approximately $2.5 million in 2005 dollars. See Measuringworth.com at http://www.measuringworth.com/uscompare/. Accessed March 25, 2007.
(105) Harriet M. Felton and Celia Y. Willard, 'Current Status of Prophylaxis by Haemophilus Pertussis Vaccine,' Journal of the American Medical Association 126 (September 1944): 294-99; Baker, 'Immunization and the American Way,' 202. On the growing production of whooping-cough vaccine in Michigan, see H. Allen Moyer, 69th Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1941 (Lansing: Franklin DeKleine, 1941), 74-76.
(106) See Annual Reports of the Commissioner of the Michigan Department of Health for the years 1930 to 1972. For Michigan whooping-cough statistics, see Eldering, 'Whooping Cough Studies in Grand Rapids and Kent County,' 221.
(107) Richard H. Steckel, 'Incidence rates of selected reportable diseases: 1912-1998,' Table Bd457, in Historical Statistics of the United States: Earliest Times to the Present, ed. Susan B. Carter et al. (New York: Cambridge University Press, 2006), 2: 564-65; Michael R. Haines, 'Death rate, by cause: 1900-1998,' Table Ab929-951, in ibid., 1: 463-64.
(108) Charles R. Manclark, 'Pertussis Vaccine: The First Pearl Kendrick Commemorative Lecture' (handwritten notes in author's files), Symposium: Status and Prospects in Immunization, Ann Arbor, February 19, 1982. After 1948 the National Institutes of Health required that all pertussis vaccines be tested with the mouse-protection assay. Grace Eldering, 'Whooping Cough Studies in the Laboratories of the Michigan Department of Health,' delivered to Sigma Xi meeting at Michigan State College, November 11, 1952, typescript, Correspondence-Whooping Cough, 1943-1972 folder, B1, F10, Grace Eldering Papers, State of Michigan Archives, Lansing.
(109) Dr. Kenneth Wilcox, telephone interview by author, August 25, 1999; written recollections of Jack Holwerda, January 16, 2000, copy in author's files.
(110) Bunney et al., 'History of the Antigen Committees.'
(111) Edwin O. Jordan and William Burrows, Textbook of Bacteriology, 14th ed. (Philadelphia: W. B. Saunders, 1946), 471; Kendrick and Eldering, 'A Study in Active Immunization.'
(112) On Healthiest City contests, see Leavitt, Healthiest City, 214. A. H. Edwards to C. Sophus Johnson, April 25, 1935, no. 65324; September 17, 1934, no. 64049, both in GRCCD. On the role of the chamber of commerce in organizing the city's entries into these competitions, see Chamber of Commerce, Director's Minutes, vol. 12, September 9, 1930; vol. 13, April 27, 1931; vol. 15, June 13, 1933; vol. 17, September 10, 1935; and vol. 18, August 12, 1936, Grand Rapids Association of Commerce, box 37, collection #46, GRPLSC.
(113) On the continued honors, see C. Sophus Johnson to the Mayor and City Commission, November 3, 1938, no. 72561; April 20, 1939, no. 73416, both in GRCCD.
(114) Biographical data form for Who's Who of American Women.
(115) Bunney et al., 'History of the Antigen Committees.'
(116) For example, see David Evans to Pearl Kendrick, March 23, 1946, Pertussis Correspondence-Foreign-England' folder, box 3, Kendrick Papers. This subject arose in the author's interviews with Aina Valdmanis, December 1, 1999, Grand Rapids; Gordon, March 19, 1998; and Redland, November 11, 1999; and in the written recollections of Jack Holwerda.
(117) Kenneth W. Cochran, speaking at 'Symposium on Pertussis Immunization.' John Will noted both women's dedication to the community, adding that 'in her own modest way,' Grace Eldering was % powerful leader,' even though her 'lifestyle and manner camouflaged this.' John Will, interview by author, May 15, 2002, Grand Rapids, Mich.
(118) 'Dr. Kendrick, Famed Bacteriologist, Dies,' Grand Rapids Press, October 9, 1980, clipping file, Biographical and Genealogical folder, box 1, Kendrick Papers.
(119) Eldering, 'Whooping Cough Studies in Grand Rapids and Kent County,' 224.
Carolyn G. Shapiro-Shapin is an associate professor in the Department of History at Grand Valley State University.
