April 4, 2017
Paralytic poliomyelitis, most commonly referred to as polio, once immobilized a nation in fear as the disease paralyzed children with no known cause. In the early 1950s, there were roughly 20,000 cases of polio diagnosed per year. In 1952, at the height of the epidemic, the disease took more than 3,000 lives (Sokol, 1997). Thankfully within the same year, Jonas Salk created an effective vaccine. In 1955, after almost three years of testing, the Salk polio vaccine was announced to the world. Salk’s vaccine was a medical relief to the nerves of many.
Babies and Breadwinners was a government film documenting the mass Polio Vaccination Campaign of 1961. “This title referred, of course, to those two poorly immunized groups, the children five years and under and the young adults,” wrote Dr. Maynard Mires in the Delaware Medical Journal (Mires, 1961).
The film, produced by the Communicable Disease Center (more presently known as the Center for Disease Control and Prevention), was to be informative and encouraging in the implementation of mass vaccination campaigns across the nation.
Set in the city of Columbus, Georgia, the film documented the first of three phases of a vaccination campaign. Thirty-eight locations were set-up across the city over eight days. Vaccinations were free. People walked up, were vaccinated with the Hypospray Multidose Jet Injector, and then continued on their merry way. “A simple injection means polio protection.”
The film also documented the lack of sterilization between jet gun inoculations. In the photo above, taken from the event in downtown Columbus, the vaccinator held the Hypospray Jet Injector in one hand and appropriately held the patient’s arm with his other hand. The jet injector was attached to a motor enclosed in a carrying-case on the table. Also placed upon the table, near the center, is a vaccine vial and a red protective cap to cover the jet injector nozzle when not in use. Upon the far right side of the table is a microphone belonging to the cameraman in the black suit. There appears to be a material object on the bench below the table, although this object remains unclear. As the video demonstrates, a nurse standing to the right side wipes the patient’s arm with cotton dipped in acetone. The jet injector, however, was used consecutively person after person. The nozzle was never wiped in between vaccinations.
Video footage also captured vaccinators reaching toward the nozzle following injections. A snapshot of the video, above, demonstrates this action. A 1966 self-instructional lesson by the CDC, titled “Jet Injector Operation, Model K3,” pictured below, informs vaccinators how to use the Hypospray Multidose Jet Injector and explains this behavior. Before administering an injection the vaccinator must turn the cocking lever from the “Fill” position to the “Injection” position. Then immediately following the injection, the cocking lever must be turned-back to the “Fill” position to allow the vaccine vial to fill the drug reservoir with the next dosage.
The video footage also captured a disregard for protocol. The CDC’s operating instructions stated, “Squeeze trigger for full THREE SECONDS (count: ‘One thousand one, one thousand two, one thousand three’).” Yet the film repeatedly documented vaccinators holding the jet injector for only one second, as shown in the clip below. Also note the nozzle was never wiped or cleansed in between injections.
In two instances the video captured the wiping of the injection site immediately following the jet injection. The incidents were unique as the video demonstrates the majority of the vaccinees did not have their arm wiped. In the following clip, a nurse cleansed a girl’s arm with cotton dipped in acetone whereupon a vaccinator administered an injection. Afterwards the nurse immediately wiped the girl’s arm, in a downward motion, with the same cotton. (You may need to watch twice to capture the motion). The girl then clutched her arm as her mother carried her away. The nurse discarded the dirty cotton which accidentally landed on the table. Then the next child stepped forward to receive a vaccination. The jet injector nozzle was never wiped or cleansed.
In another clip, a boy, appearing in the foreground, had just received a vaccination. Holding a piece of cotton within his left hand he wiped the injection site on the deltoid area of his right arm.
So why was the post-injection wiping important?
If the jet gun was held firmly against the vaccinee’s skin, and immediately following the injection there was a need to wipe the injection site of the vaccinee, then whatever was on the vaccinee’s arm was also on the nozzle of the jet injector. Despite the fact that we do not know what was being wiped, whether the substance was blood, splash-back of vaccine after after penetrating the outer layer of skin or a combination thereof, this footage demonstrates at that time the jet injector was contaminated and no longer sterile.
In our series, Faulty Design Created Inherent Risk, Mitragotri (2006) demonstrates through microcinematography the nozzle becomes contaminated through a phenomenon known as splash-back.
The complete video can be accessed here.
- (Mitragotri, 2006) Mitragotri S. Current status and future prospects of needle-free liquid jet injectors. Nature Reviews Drug Discovery 5:543–548, 2006.
- (Mires, 1961) MH Mires. Babies and Breadwinners. Delaware Medical Journal. September 1961. pp. 270-272.
- (Sokol, 1997) Sokol B. Fear of Polio in the 1950s. [Online Article] Available at: http://www.plosin.com/beatbegins/projects/sokol.html.
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