NOTES WASHED UP IN A BOTTLE
Donald W. MacCorquodale, MD, MSPH

The first day of my junior year in medical school, my classmate, Mike Lubchenko, and I started to work in the laboratory of the outpatient department of Colorado General Hospital in Denver. Every patient who was visiting the outpatient department for the first time had to have a smallpox vaccination.

A man in his early fifties entered the laboratory, and Mike told him that he was going vaccinate him for smallpox. The fellow rolled up his sleeve revealing an arm covered with red, angry lesions, and he said, “Do you think I should be vaccinated? I have terrible eczema.”  Mike looked toward the technician in charge of the lab, and she shook her head vigorously. She meant ‘don’t do it,’ but Mike  thought she was trying to say ‘don’t let him talk you out of it.’ So, he immediately vaccinated the man who returned to the lab a few days later.  He was covered from head to toe with vesicles, some of them purulent. A blister had appeared every place on his body where he had an eczema lesion, and he was absolutely miserable. He was admitted to the hospital as a teaching case for medical students.

We had an older physician on the volunteer teaching staff, Dr. Armin Barney, the most gifted doctor in the art of physical diagnosis I have ever known. He presented the patient, who had been inadvertently vaccinated, to a group of medical students every morning. I remember he told our group that the fellow covered with vesicles looked exactly like a case of smallpox.  He added that we would probably never see a patient with smallpox, but he urged us to remember the appearance of the poor man covered with those lesions. I’ve never forgotten him, but happily, I’ve never seen a case of smallpox since I graduated from medical school some 57 years ago.

Smallpox has been a dread disease since the beginning of time.  Periodic outbreaks of the disease killed about 30% of those afflicted and left those who recovered terribly scarred. All that changed with the work of Edward Jenner, a physician in a small town in England. He was not the first to vaccinate against small pox, but he popularized the procedure. For example, a Boston physician, Zabdiel Boylston, inoculated his son and two African American slaves and somewhat later, an additional 244 persons, during an outbreak of smallpox in Boston in 1721. This evoked vehement opposition, and the good doctor was threatened with hanging.

Dr. Jenner vaccinated a boy named James Phipps using material from the cow-pox lesions of a milk maid. Six weeks later he inoculated James with the smallpox virus, but the boy did not develop the disease. By 1798 Jenner had vaccinated 23 cases, which he reported in a brief paper entitled “An Inquiry into the Causes and Effects of Variola Vaccinae.”

The Vaccination Act of 1840 made smallpox vaccination compulsory in England for all children under the age of 14 years. After nearly 60 years of protest from men and women, who regarded enforced vaccination as a violation of personal liberty, penalties were abolished in 1898 and replaced by a clause of conscience. The latter allowed parents who did not believe vaccination was safe or effective to get a certificate of exception.

Opposition to vaccination continues. There is widespread opposition to immunizing infants with the MMR vaccine (measles, mumps, and rubella) in this country and in England among parents convinced that the MMR vaccine causes autism, a frightful developmental disorder. Symptoms of the latter usually appear during the first three years of life, including the  inability to become friends with other children, the inability to sustain a conversation, and repetitive movements.

Representative Dan Burton (R-Indiana) has a grandson, who suffers from autism, and he is convinced his grandson’s disorder is the result of his being immunized with the MMR vaccine. Representative Burton has made his opposition to MMR immunization highly visible by holding hearings on autism and verbally abusing expert medical witnesses, who do not share his views. A number of these hearings have been shown on television.

The Institute of Medicine (IOM) studied the issue at the request of the Centers for Disease Control, and it concluded there was no association between the MMR vaccine and autism. After an independent study, the American Academy of Pediatrics reached the same conclusion. The United Kingdom’s Committee on the Safety of Medicine failed to find a relationship between vaccines and autism. Representative Burton’s response to the IOM report was to accuse the Institute of being in cahoots with the manufacturers of vaccine.

So, opposition to vaccination goes on and on. In all likelihood it seems that like the poor, it will be with us always.