by The Pandemic Century- One Hundred Years of Panic, Hysteria
CHARLIE ARMSTRONG is a type that has almost disappeared from American medicine today: a scientist equally at home in the laboratory and the field, who combined serious medical research with a career devoted to fighting infectious disease and improving public health. A graduate of Johns Hopkins Medical School, Armstrong’s interest in public health was fired by his early experiences as medical officer in the US Marine Hospital Service on Ellis Island in 1916, where it was his job to examine immigrants suspected of introducing diseases like trachoma and typhus to the United States. Two years later, as an assistant surgeon on the Seneca, a US coast guard cutter on escort duty in the Atlantic, he had witnessed the first wave of Spanish flu when an outbreak occurred on his boat off the coast of Gibraltar, prompting him to hoist the yellow quarantine ensign. Later, while serving at the Fore River Shipyard, near Boston, Armstrong had also treated sailors affected by the deadly second wave. It was an experience he would never forget. Asked years later what the flu was like, he told a reporter: “with influenza you think you are going to die and afraid that you won’t.” After the war, Armstrong was posted to the Ohio Department of Health, where he continued his investigations into influenza and honed his epidemiological skills. Then, in 1921, he was posted to the Hygienic. He would remain there until his retirement in 1950, a period in which he would also contract malaria, dengue fever, encephalitis, Q fever, and tularemia. Despite the risks that his laboratory work exposed him to, however, Armstrong was a tireless investigator. His most notable contribution to scientific research came in 1934 when he isolated a new neurotropic virus—a virus with affinity for nerve tissue, which he named lymphocytic choriomeningitis, from the spinal fluid of monkeys artificially infected with material from the 1933 St. Louis encephalitis epidemic. This was followed, in 1940, by the first transmission of a polio virus from monkeys to rats and mice, an experimental innovation that laid the ground for subsequent investigations into the immunology of the disease and the development of human polio vaccines. Awarded the Sedgwick Memorial Medal of the American Public Health Association the following year, Armstrong was hailed as someone who had made “a distinct contribution to the knowledge of every disease with which he has worked.” In short, he was the epitome of the male microbe hunter. As de Kruif put it, Armstrong was “thick set, with reddish hair and round china-blue eyes set wide apart in a face that couldn’t keep from smiling,” and definitely not the sort of man who would “own a parrot let alone kiss it.” In spite of his skepticism about parrot fever, however, when McCoy summoned him to his office, Armstrong immediately agreed to drop his vaccine experiments and travel to Annapolis to see if there was any truth in the rumor.
According to de Kruif, by now requests for information about the mysterious new disease were pouring into Washington, and Cumming’s desk was piled with “stacks of yellow and blue slips.” For once, de Kruif was not exaggerating. In her history of the PHS, Bess Furman reports that by early January thirty-six cases of suspected psittacosis had been reported to the surgeon general, and his desk was “deluged” with urgent telegrams. Like all good disease detectives, Armstrong headed to the scene of the crime: Lillian’s bedside. Her pet parrot had long been buried but she still had the cage and, miraculously, it still contained some of the bird’s droppings. Following protocol, Armstrong shared some of the cleanings from the cage with William Royal Stokes, the head of bacteriology at the Baltimore Department of Health, so that he could conduct independent tests. Before returning to Washington, Armstrong warned Stokes to be careful when culturing organisms from the material, reminding him that many people suspected that psittacosis “might be a virus,” not a bacterium. Stokes promised to heed Armstrong’s warning, but within a matter of weeks he would be dead.
By January 8, 1930, Lillian and her son and daughter-in-law were not the only ones thought to have parrot fever. Four employees of the pet store at North Eutaw Street were also ill, as was a woman who had bought a parrot at another store in southeast Baltimore. Then, on January 10, came the fatalities. The first victim was a Baltimore woman, Mrs. Louise Schaeffer, whose death had originally been attributed to pneumonia; it was only when Baltimore health officials questioned her family that it emerged she had been in contact with a parrot several days earlier. However, it was the second death that really alarmed health officials because it occurred in Toledo, Ohio, nearly five hundred miles to the northwest of Baltimore. The victim was Mrs. Percy Q. Williams. She had died at Toledo’s Mercy Hospital three weeks after her husband had returned from Cuba with a gift of three parrots (one of the parrots had died shortly after his return). It was the first indication of the true extent of the epidemic and the challenge facing state and federal health officials. Cumming had previously avoided making a public statement. Now he had no choice. He “did not fear an epidemic,” he said, as it was generally believed that psittacosis was transmitted “only from bird to human being, and not from person to person.” Nevertheless, he advised Americans to avoid handling recently imported parrots until the completion of Armstrong’s investigation. “There is at present no indication of widespread prevalence of the disease, but I would urge that people avoid contact with possible conveyors, the birds.”
Cumming’s statement was all that newspapers needed to run with the story. Even the New York Times displayed the reports prominently. “Parrot Fever Kills 2 In This Country,” it declared on January 11, placing the story at the top of page 3. “Woman in Baltimore and Another in Toledo are Victims of Rare Disease. Eleven others are ill,” continued the subhead. The following day, with reports of further suspect cases in Ohio involving several clerks in the poultry department of a Toledo store, the New York Times promoted the story to page one. “Hunts For Source of ‘Parrot Fever,’ ” it declared, above a report describing the efforts of Baltimore state health officials and the Bureau of Animal Industry and Biological Survey to confirm the source of the parrots sold in Baltimore pet shops. “We do not consider it practical to place an embargo on importation before making sure where the sick parrots are coming from,” stated Cumming in a game attempt to reassure an increasingly nervous public.
By the middle of January, Baltimore officials working with colleagues from the state health department had visited seven pet stores in the city and the homes of thirty-eight people who had recently purchased parrots. Of these, thirty-six were ill with the same symptoms as the Kalmeys. This so alarmed Daniel S. Hatfield, the director of the Bureau of Communicable Diseases, that he ordered an immediate moratorium on the sale of parrots and the isolation of all birds seized in Baltimore pet stores. However, Hatfield was not so cautious when it came to protecting his own health, and on January 19, while assisting Stokes, he contracted psittacosis and was rushed to Baltimore’s Mercy Hospital. Hatfield was lucky. Unlike Stokes, who by now was autopsying parrots daily and, presumably, exposing himself to massive amounts of virus, he had a mild case of the disease and survived.
If there was any doubt before about the role of foreign birds, the Baltimore investigations dispelled them: out of the seven pet shops investigated, four were shown to be the source of diseased parrots. Nearly all were traced to shipments from Central or South America that had come via dealers in New York. If that was the case, it was highly likely that those same dealers had sold diseased birds to pet stores in other cities. Sure enough, when Armstrong wired public health officials across the country he was inundated with information, and birds, both dead and alive, began arriving from Baltimore, Maine, Chicago, New Haven, and Los Angeles. And as more and more cases came to light, so the death toll crept up. Women, many of them widows, constituted the majority of victims, most likely because they were the principal recipients of lovebirds. Peddlers usually sold the birds singly to facilitate their bonding with their owners. Women were also most likely to kiss the birds affectionately, or care for them when they fell sick. By the final week in January, more than fifty cases had been reported nationwide, including fourteen in New York, where, under pressure from the city’s health
commissioner, bird dealers were forced to accept a voluntary embargo. Soon, orphaned birds began turning up all over the city, including in the vestibule of a house in East Elmhurst, Queens. Taking pity on the young foundling, which had a chipped beak, the householder turned it over to the Society for the Prevention of Cruelty to Animals. “Fear of psittacosis,” reported the New York Times, “is thought to be the reason for the abandonment of the bird.”
At this point, the only persons interested in collecting parrots were Armstrong and his assistant, “Shorty” Anderson (so called because he stood just five feet six inches tall). By January 16, Armstrong and Anderson had everything they needed to conduct bacteriological tests: parrots both dead and alive, the scrapings from Lillian’s birdcage, and blood from human patients. Well aware that the birds were highly contagious and that they were probably dealing with a “filter-passing” virus, Armstrong decided to confine the experiments to two small dark rooms in the basement of the Hygienic. According to de Kruif, these rooms were “dank, frowsty little holes hardly bigger than coal bins, [and] an insult to offer to any self-respecting microbe hunter for a laboratory.” Worse, the healthy birds were “clawing green devils,” who were constantly scrabbling to escape their cages or scattering food and fecal droppings onto the floor. To try to contain them, Armstrong and Anderson placed the most violent birds in cages they’d rigged from metal garbage cans enclosed with wire mesh covers. In addition, they kept the birds behind moist curtains soaked in disinfectant and put troughs containing creosol in the doorways. They also periodically scrubbed the walls with disinfectant and wore heavy rubber gloves and aprons when extracting birds from their cages. Nevertheless, de Kruif considered the Hygienic one of the most “odiferously untidy” buildings he had ever visited. The Rockefeller virologist, Thomas Rivers, a leading authority on filterable viruses, concurred, remarking that the only thing hygienic about the building was its name.
Despite this unpromising working environment, however, within days Armstrong had succeeded in communicating the disease from sick to healthy birds using either the droppings from infected birds or ground-up tissue from a dead parrot (according to de Kruif, the deceased bird came from Stokes in Baltimore). Armstrong also observed that while some of the sick birds died, many survived inoculation with infective material, after which they became asymptomatic carriers.§ According to de Kruif, Anderson was particularly adept at grabbing the parrots without getting “gaffed” by them. Just days before, both men had considered themselves “parrot ignoramuses.” Now, “by a little jab of next to nothing through a needle,” the birds were sitting hunched in their cages “with their heads bent forward,” and Armstrong and Anderson had the feeling they were “getting control of this weird disease.” Try as they might, however, they could not isolate the bacillus described by Nocard, or culture any other organism from the ground-up material. It seemed increasingly likely that psittacosis was a filter-passer that could only be transmitted from bird to bird or from bird to human by close contact. But how precisely the virus was conveyed from parrots and whether people were also capable of transmitting it independently of birds, was anyone’s guess. Perhaps patients communicated the virus via the respiratory route when they coughed infectious material? If that was the case, it might become as transmissible as flu. Clearly, it was imperative to make a serum before the unthinkable happened and psittacosis became a true pandemic.
Armstrong would need that serum sooner than he anticipated. Based on the initial results of his investigation, on January 24 President Herbert Hoover issued an Executive Order prohibiting “the immediate importation of parrots into the United States, its possessions and dependencies from any foreign port” until such time as the causative organism and its means of transmission could be ascertained. Unfortunately, when Armstrong strode into the “old red brick building on the hill” to resume the investigation the following morning he found Shorty slumped over his desk, complaining of a high fever and a “rotten headache.” Normally, when work was going well Shorty was “all smiles and cheerful profanity.” A born “lab-swipe,” Shorty was never happier than when he was microbe-hunting, claimed de Kruif. “Now he looked awful.” It was not difficult to diagnose the cause of his malaise. Armstrong arranged for him to be admitted to the US Naval Hospital, where X-rays showed a sinister cloud at the base of his left lung. It was at this point that McCoy stepped in and, over the objections of his employees and family, joined Armstrong in the basement. As McCoy tried to mimic Shorty’s technique of gaffing the birds, Armstrong rushed back and forth between the laboratory and the hospital to check on his assistant’s condition. There was little sign of improvement, and in desperation Armstrong drew blood from Shorty’s veins and collected expectorations from his bedsheets in order to inoculate the fluids into parrots and other test animals. At the same time, to see how parrots became infected, he and McCoy also placed parts of dead parrots in cages along with healthy birds. Armstrong may have thought that by co-opting Shorty into the experiments, he would buy his assistant some more time. But though he was able to confirm that psittacosis was a filter passer, he could not forestall the inevitable and on February 8 Shorty died. Scrupulous about paying his bills, his last request was that Armstrong settle his outstanding debts.
Unfortunately, it was a request Armstrong was unable to honor as that very day he was also admitted to the hospital. As Shorty was laid to rest in Arlington National Cemetery with full military honors (he was an ex-navy man), Armstrong’s temperature spiked from 102° to 104° F. The following day, an X-ray showed a white shadow enveloping his left lung, confirmation that he had pneumonia and was almost certainly infected with the same bug. When McCoy saw the X-ray he decided to take a gamble by using a method of unknown and questionable value: namely, the administration of convalescent blood serum. It had been known since the 1890s that survivors of diphtheria and other bacterial diseases were immune to reinfection, and that their immunity was associated with antibodies circulating in their blood. Moreover, if their blood was purified and the antibodies separated from the red corpuscles, the resulting serum could also be used to protect immune-naïve individuals from the same diseases. By the 1920s, this principle was also being applied to viral diseases, such as influenza and polio, but although the transfer of passive serum from survivors of flu and polio sometimes appeared to confer protection, it was far from clear if this protection was due to the serum or some other factor. Moreover, since there was no way of screening blood for impurities in the 1920s, physicians had no way of knowing whether or not passive serums contained active viral material or some other undiscovered virus, such as hepatitis. Ironically, one of the biggest serum skeptics of all was McCoy. Hardly a month went by without a claim from some fly-by-night pharmaceutical firm that it had developed a serum for pneumonia or meningitis. As the head of the Hygienic, it was McCoy’s job to examine these requests and deny licenses to those he considered questionable. Now, he threw caution to the wind and instructed Roscoe Spencer of the Rocky Mountain Laboratory to head the search for potential serum donors. Spencer had recently developed a vaccine against spotted fever, a tick-borne disease endemic to Montana and some midwestern states—an endeavor for which he would be awarded the gold medal of the American Medical Association—and was quite happy to turn errand boy to help a fellow microbiologist stricken in the line of duty. According to de Kruif, the serum came from an elderly Maryland lady who graciously refused payment for her blood. Others report Spencer procured the precious serum from a physician at Johns Hopkins Hospital in Baltimore. What is not in dispute is that within hours of the serum entering his veins, Armstrong rallied and his condition improved.
Over the next two weeks, as Armstrong grew stronger, McCoy continued his investigation, mashing up the livers and spleens of dead parakeets before passing them through filters and inoculating the filtrate into healthy birds. Fearing further infections, McCoy forbade his staff from entering the makeshift laboratory in the basement of the north building of the Hyg
ienic Laboratory, and from February 7 insisted on conducting the autopsies of parrots and disposing of their carcasses in person. At this point, it was still not known whether psittacosis could be communicated from person to person or whether the microbe was also conveyed as an aerosol in dust particles. To minimize the risk of accidental contamination, the only person McCoy allowed to approach the basement laboratory was the general foreman whose job it was to bring sandwiches for McCoy and feed for the birds. He usually handed these items to McCoy at the threshold and did not enter the rooms himself. To reduce the chances of the sick birds accidentally spreading the infection to healthy parrots, McCoy also strung a muslin curtain across the archway between the laboratory rooms and wetted the floor each morning with creosol. Nevertheless, on occasion, McCoy would find diseased parrots, who had somehow freed themselves from the cages, wandering in a room reserved for healthy birds.
Despite these precautions, within eight days of Armstrong’s illness several other staff at the Hygienic had also fallen ill. The first casualty was the north building’s night watchman, Robert Lanham, who came on duty at midnight and left every morning at 8 a.m., a period when laboratory work was suspended and no autopsies were being carried out. Lanham’s only risk was that he had briefly been in the same room as Anderson on January 27, the day Shorty fell ill. However, Lanham had fallen sick eighteen days later, which was well outside the presumed incubation period.
The next person to contract psittacosis was a laboratory assistant, whose symptoms became apparent on February 28. Unlike Lanham, she had never breathed the same air as someone incubating psittacosis. However, her office was next door to the basement room where McCoy kept the healthy birds, and she had also handled material for culturing the organism, though since her principal role was to look for salmonella and streptococci McCoy thought it unlikely that she could have been exposed to psittacosis this way. However, the next group of casualties left McCoy in no doubt that his precautions had failed and that the north building was thoroughly contaminated. The first to fall ill was a medical officer whose office was on the side of the corridor opposite the autopsy room. The next day, March 11, the general foreman was also taken ill, followed in quick succession by two cleaners and two bacteriologists engaged in research on other diseases. Except for McCoy, no one escaped the disease. Even Ludvig Hektoen, a distinguished pathologist and chairman of the National Research Council, who was doing private research at the Hygienic and had merely spent his afternoons in one of the rooms, was admitted to the hospital.