EXPERIMENTS TO DETERMINE MODE
OF SPREAD OF INFLUENZA
MILTON J. ROSENAU, M.D.
BOSTON
The experiments here described were performed on
an island in Boston Harbor, on volunteers obtained
from the Navy. The work was conducted by a group
of officers detailed for that purpose, from the U. S.
Navy and the U. S. Public Health Service, consisting
of Dr. G. W. McCoy, director of the Hygienic
Library, Dr. Joseph Goldberger, Dr. Leake, and Dr.
Lake, all on the part of the U. S. Public Health Service; and cooperating with those medical officers, was
a group also detailed for this purpose on the part of
the U. S. Navy, consisting of Dr. J. J. Keegan, Dr.
De Wayne Richey and myself.
The work itself was conducted at Gallops Island,
which is the quarantine station of the Port of Boston,
and peculiarly well fitted for operations of this kind,
serving adequately for the purposes of isolation,
observations, and maintenance of the large group of
volunteers and personnel necessary to take care of
them.
The volunteers were all of the most susceptible
age, mostly between 18 and 25, only a few of them
around 30 years old ; and all were in good physical
condition. None of these volunteers, 100 all told in
number, had "influenza ;" that is, from the most care¬
ful histories that we could elicit, they gave no account
of a febrile attack of any kind during the winter,
except a few who were purposely selected, as having
shown a
typical attack of influenza, in order to test
questions of immunity, and for the purpose of control.
Now, we proceeded rather cautiously at first by
administering a pure culture of bacillus of influenza,
Pfeiffer's bacillus, in a rather moderate amount, into
the nostrils of a few of these volunteers.
These early experiments I will not stop to relate,
but I will go at once to what I may call our Experi¬
ment 1.
EXPERIMENTS AT GALLOPS ISLAND
As the preliminary trials proved negative, we became
bolder, and selecting nineteen of our volunteers, gave
each one of them a very large quantity of a mixture of
thirteen different strains of the Pfeiffer bacillus, some
of them obtained recently from the lungs at necropsy;
others were subcultures of varying age, and each of the
thirteen had, of course, a different history. Suspen
sions of these organisms were sprayed with an atomi¬
zer into the nose and into the eyes, and back into the
throat, while the volunteers were breathing in. We
used some billions of these organisms, according to
our estimated counts, on each one of the volunteers,
but none of them took sick.
Then we proceeded to transfer the virus obtained
from cases of the disease ; that is, we collected the
material and mucous secretions of the mouth and nose
and throat and bronchi from cases of the disease and
transferred this to our volunteers. We always
obtained this material in the same way : The patient
with fever, in bed, has a large, shallow, traylike
arrangement before him or her, and we washed out one
nostril with some sterile salt solution, using perhaps
5 ce., which is allowed to run into this tray ; and that
nostril is blown vigorously into the tray. This is
repeated with the other nostril. The patient then
gargles with some of the solution. Next we obtain
some bronchial mucus through coughing, and then we
swab the mucous surface of each nares and also the
mucous membrane of the throat. We place these
swabs with the material in a bottle with glass beads,
and add all the material obtained in the tray. This is
the stuff we transfer to our volunteers. In this par¬
ticular experiment, in which we used ten volunteers,
each of them received a comparatively small quantity
of this, about 1 c.c. sprayed into each nostril and into
the throat, while inspiring, and on the eye. None of
these took sick. Some of the same material was fil¬
tered and instilled into other volunteers but produced
no results.
Now, I may mention at this point that the donors
were all patients with influenza iti Boston hospitals ;
sometimes at the U. S. Naval Hospital at Chelsea,
sometimes at the Peter Bent Brigham Hospital, where
we had access to suitable cases. We always kept in
mind the fact that we have no criterion of influenza ;
therefore I would like to emphasize the fact that we
never took an isolated case of fever, but selected our
donors from a distinct focus or outbreak of the dis¬
ease, sometimes an epidemic in a school with 100 cases,
from which we would select four or five typical cases,
in order to prevent mistakes in diagnosis of influenza.
Now, thinking that perhaps the failure to reproduce
the disease in the experiments that I have described
was due to the fact that we obtained the material in
the hospitals in Boston, and then took it down the bay
to Gallops Island, which sometimes required four
hours before our volunteers received the material, and
believing that the virus was perhaps very frail, and
could not stand this exposure, we planned another
experiment, in which we obtained a large amount of
material, and by special arrangements, rushed it
down to Gallops Island ;
so that the interval between
taking the material from the donors and giving it to
our volunteers was only one hour and forty minutes,
all told. Each one of these volunteers in this experi¬
ment, ten in number, received 6 c.c. of the mixed stuff
that I have described. They received it into each
nostril ;
received it in the throat, and on the eye ;
and
when you think that 6 c.c. in all was used, you will
understand that some of it was swallowed. None of
them took sick.
Then, thinking perhaps it was not only the time
that was causing our failures, but also the salt solution
•—for it is possible that the salt solution might be
inimical to the virus—-we planned another experiment,
to eliminate both the time factor and the salt solution,
and all other outside influences. In this experiment we
had little cotton swabs on the end of sticks, and we
transferred the material directly from nose to nose
and from throat to throat, using a West tube for the
throat culture, so as to get the material not only from
the tonsils, but also from the posterior nasopharynx.
We used nineteen volunteers for this experiment,
and it was during the time of the outbreak, when we
had a choice of many donors. A few of the donors
were in the first day of the disease. Others were in
the second or third day of the disease. None of these
volunteers who received the material thus directly
transferred from cases took sick in any way. When
I say none of them took sick in any way, I mean that
after receiving the material they were then isolated
on Gallops Island. Their temperature was taken three
times a day and carefully examined, of course, and
under constant medical supervision they were held
for one full week before they were released, and per¬
haps used again for some other experiment. All of
the volunteers received at least two, and some of them
three "shots" as they expressed it.
Our next experiment consisted in injections of
blood. We took five donors, five cases of influenza in
the febrile stage, some of them again quite early in
the disease. We drew 20 'c.c. from the arm vein of
each, making a total of 100 c.c, which was mixed and
treated with 1 per cent, of sodium citrate. Ten c.c. of
the citrated whole blood were injected into each of the
ten volunteers. None of them took sick in any way.
Then we collected a lot of mucous material from the
upper respiratory tract, and filtered '
it through Mandler filters. While these filters will hold back the
bacteria of ordinary size, they will allow "ultramicroscopic" organisms to pass. This filtrate was injected
into ten volunteers, each one receiving 3.5 c.c. subcutaneously, and none of these took sick in any way.
The next experiment was designed to imitate the
natural way in which influenza spreads, at least the
way in which we believe influenza spreads, and I have
no doubt it does—by human contact. This experi¬
ment consisted in bringing ten of our volunteers from
Gallops Island to the U. S. Naval Hospital at Chelsea,
into a ward having thirty beds, all filled with influenza.
We had previously selected ten of these patients to
be the donors ; and now, if you will follow me with
one of our volunteers in this ward, and remember that
the other nine were at the same time doing the same
thing, we shall have a picture of just what was hap¬
pening in this experiment :
The volunteer was led up to the bedside of the patient; he
was introduced. He sat down alongside the bed of the patient.
They shook hands, and. by instructions, he got as close as
he conveniently could, and they talked· for live minutes. At
the end of the five minutes, the patient breathed out as hard as
he could, while the volunteer, muzzle to muzzle (in accord¬
ance with his instructions, about 2 inches between the two),
received this expired -breath, and at the same time was
breathing in as the patient breathed out. This they repeated
five times, and they did it fairly faithfully in almost all of
the instances.
After they had done this for five times, the patient coughed
directly into the face of the volunteer, face to face, five différ¬
ent times.
I may say that the volunteers were perfectly splendid about
carrying out the technic of these experiments. They did it
with a high idealism. They were inspired with the thought
that they might help others. They went through the program
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in a splendid spirit. After our volunteer had had this sort of
contact with the patient, talking and chatting and shaking
hands with him for five minutes, and receiving his breath five
times, and then his cough five times directly in his face, he
moved to the next patient whom we had selected, and
repeated this, and so on, until this volunteer had had that
sort of contact with ten different cases of influenza, in differ¬
ent stages of the disease, mostly fresh cases, none of them
more than three days old.
We will remember that each one of the ten volunteers
had that sort of intimate contact with each one of the
ten different influenza patients. They were watched
carefully for seven days—and none of them took sick
in any way.
EXPERIMENTS AT PORTSMOUTH
At that point, the holidays came, our material was
exhausted, and we temporarily suspended our work.
In fact, we felt rather surprised and somewhat per¬
plexed, and were not sure as to the next way to turn,
and we felt it would be better to take a little breathing
spell and a rest.
We started another set of experiments in February that lasted into March, again using fifty volunteers
carefully selected from the Deer Island Naval Train¬
ing Station. These experiments I will not give in
detail. They would take too long. They were simply
designed and the program was carefully planned, but
the way matters turned out became very confusing
and perplexing. I will give two instances to explain
what I mean by that ; and I give them because they are
exceedingly instructive and very interesting.
In February and March, the epidemic was on the
wane. We had difficulty in finding donors. We were
not sure of our diagnosis, having no criterion of influ¬
enza. We therefore felt very fortunate when we
learned of an outbreak that was taking place at the
Portsmouth Naval Prison, only a few hours north of
Boston. We at once loaded a couple of automobiles
filled with our volunteers, and rushed up to Ports¬
mouth, and there repeated many things that I have
described in our first set of experiments. At Ports¬
mouth, out of a large number of cases, we made our
selections carefully, taking the typical cases for donors,
and transferring the material directly to our volun¬
teers. In about thirty-six hours, half of the number
we exposed came down with fever and sore throat,
with hemolytic streptococci present, and doubtless as
the causal agent. All the clinicians who saw these
cases in consultation agreed with us that they were
ordinary cases of sore throat.
Another incident : One of our officers, Dr. L., who
had been in intimate contact with the disease from
early in October, collected material from six healthy
men at the Portsmouth Navy Yard who were thought
might be in the period of incubation of the disease—we
were trying to get material as early as possible, because
all the evidence seems to indicate that the infection is
transmittable early in the disease. None of the six
men came down with influenza, but Dr. L. came down
in thirty-six hours, with a clinical attack of influenza,
although he had escaped all the rest of the outbreak.
CONCLUSION
I think we must be very careful not to draw any
positive conclusions from negative results of this kind.
Many factors must be considered. Our volunteers may
not have been susceptible. They may have been
immune. They had been exposed as all the rest of the
people had been exposed to the disease, although they
gave no clinical history of an attack.
Dr. McCoy, who with Dr. Richey, did a similar
series of experiments on Goat Island, San Francisco,
used volunteers who, so far as known, had not been
exposed to the outbreak at all, also had negative results,
that is, they were unable to reproduce the disease.
Perhaps there are factors, or a factor, in the transmis¬
sion of influenza that we do not know.
As a matter of fact, we entered the outbreak with
a notion that we knew the cause of the disease, and
were quite sure we knew how it was transmitted from
person to person. Perhaps, if we have learned any¬
thing, it is that we are not quite sure what we know
about the disease.
[A complete account of the experiment is being published
by the U. S. Public Health Service.]

Milton Joseph Rosenau (January 1, 1869 – April 9, 1946) was an American public health official and professor who was influential in the early twentieth century.

...

Rosenau left the Hygienics Laboratory at Angel Island to take on a position as Professor at Harvard University. During his time there, he helped establish the Harvard and Massachusetts School for Health Officers. He also became the president of the Society of American Bacteriologists in 1934, and later, the president of the American Public Health Association in 1944.[5]

Milton Rosenau was one of the three founders of the Harvard-MIT School for Health Officers.
“We find monuments erected to heroes who have won wars, but we find none commemorating anyone’s preventing a war. The same is true with epidemics.”

So observed Milton J. Rosenau, the Harvard Medical School professor who, along with M.I.T.’s William T. Sedgwick and Harvard’s George C. Whipple, launched the 1913 Harvard-M.I.T. collaboration that ultimately evolved into Harvard School of Public Health.

She did, however, express a somewhat similar sentiment. As pointed out by PolitiFact and Snopes, Sanger used the term “weeds” in a 1923 New York Times article she authored ( here ) ( here ), but she made no reference to a specific race. She wrote: “Birth Control is not contraception indiscriminately and thoughtlessly practiced. It means the release and cultivation of the better racial elements in our society, and the gradual suppression, elimination and eventual extirpation of defective stocks — those human weeds which threaten the blooming of the finest flowers of American civilization."

All across America, video of activists attacking statues plays on a loop while some political leaders voice their support for removing all reminders of people whose personal histories put them in a negative light. In asking for the U.S. Capitol to be cleansed of Confederate statues, House Speaker Nancy Pelosi said they must go because their efforts were “to achieve such a plainly racist end.” New York Gov. Andrew Cuomo said on NBC's "Today" show that removing statues is a “healthy expression” of priorities and values.

For those identifying historical figures with racist roots who should be removed from public view because of their evil histories, Planned Parenthood’s founder, Margaret Sanger, must join that list. In promoting birth control, she advanced a controversial "Negro Project," wrote in her autobiography about speaking to a Ku Klux Klan group and advocated for a eugenics approach to breeding for “the gradual suppression, elimination and eventual extinction, of defective stocks — those human weeds which threaten the blooming of the finest flowers of American civilization.”

Žena si na chování postěžovala posádce aerolinek Qantas, podle kterých se v týdnu podobný zážitek přihodil více ženám. „Řekli mi, že jedna se dokonce rozplakala, když byla donucena, aby si sundala tričko. Některé si stěžovaly vedení letiště,“ uvedla novinářka.