A History of [Un]Vaccinated Diseases

Brian Altonen MS MPH

1/27/2015

A Reminder to Us about the History of Diseases, before

there was Immunization

diseases covered . . .

Poliomyelitis, Measles, Chicken Pox, Small Pox, Mumps, Scarlet Fever, Diphtheria

Sources and References•Many of the black and white images in this presentation come from my Second edition copy of Franklin H. Top’s Communicable Diseases, 1947.

• Images and materials obtained from other resources are so noted on the page and/or beneath the picture.

Franklin Henry Top (1903 - )Portrait source: ihm.nlm.nih.gov

For Biog: http://medicine.yale.edu/publications/Images/M@YV3I4.pdf

Polio is by far the most devastating infectious disease to have and then survive. Unlike Small Pox, which kills or leaves a scarred survivor capable of performing daily functions . . .

Polio may leave it survivors debilitated or disabled.

Major limbs experience loss of motor function and often a paralytic like state occurs from mid-body down.

<< Polio victim in Bangladesh www.demotix.com

More examples

of polio’s impact,

from recent Web News pages

One of the major deterrents to allowing a child to have a disease during the 1960s was the fear of what other illnesses or debilitating conditions could be suffered by that child due to this experience.

With polio, for example, we sat and watched as kids went through this and demonstrated its impact on their activities. The same could be true for the whooping cough, mumps, measles, rabies, tetanus, flu and pneumonia, depending on how bad the case was.

All of us knew a family that had a bad outcome from their child becoming ill—such as deafness, the inability to attend a parochial school, the need for a wheel chair, regular PT, a reduced physical education class performance.

PoliomyelitisThe experience of Polio during the early 1950s

From the AMA Popular medical magazine: Hygieae

Poliomyelitis can result in muscular atrophy in a small percentage of its victims. As many as 75% may recover from whatever paralysis it produces.

A common treatment for these patients was to improve quality of life through “muscle re-education”, in which a physical therapist or nurse encourages and assists the patient in making the appendages move.

Hygieia (AMA)

The “hamstring” muscle is being re-educated in this patient

Muscle re-education was performed over much of the body, but we tended to focus on postural muscles and muscles used to move about with an ambulatory device. The nurse or PT in this case is stretching the back muscles of a patient, tightened due to lack of use.

Hygieia (AMA)

Exercise had to be a part of the daily plan

for recovery as part of every

muscle re-education

process.Hygieia (AMA)

Sternocleido-mastoid muscle

re-education.

Tendon stimulation by

the use of hands and pressure points over

tendons was thought to assist in this process. Hygieia (AMA)

Stretching and movement

therapymay be

performed to prevent the

tightening and reduced mobility

of joints, ligaments and

tendons. Hygieia (AMA)

“Full Packs” were used to treat Poliomyelitis bed-ridden patients.

http://www.minnpost.com/mnopedia/2012/11/sister-kenny-institute-revolutionized-treatment-polio-patients

Sister Kenny Institute revolutionized treatment of polio patientsBy R.L. Cartwright | 11/27/12

Sister Elizabeth Kenny, ca. 1911, Australia

The Sister Kenny Institute revolutionized the

treatment of paralyzed children with polio by

adding hot packs to their regimens, with the goal of

calm and soothing paralyzed muscles.

Hygieia (AMA)

(An offshoot of an early 1800s water cure practice)

Australiandoctor.com.au

Intercostal Paralysis due to

Poliomyelitis is the reason many polio

victims required respiratory assistance.

This use of an artificial respirator

to assist in breathing was

mostly employed in the 1940s and

1950s.

Relate this to the following two Public Health questions . . .

What would the cost for such a device be

today?

Could we afford it for dozens or hundreds

of new cases? Hygieia (AMA), c. 1952

Its common name:

“IRON LUNG”

Negative pressure regulator.

A Barometric Chamber used

to assist in respiration.

Hygieia (AMA), 1948

The Iron Lung was first called “Drinker Respirator”, invented 1928, by Philip A Drinker

Portrait is from: http://www.polioplace.org/people/philip-drinker-phd

June 1948Hygieia

Magazine(AMA)

Treatingthe

patient as a person

in a typical 1948

“Polio Center”

This distribution map for vaccine refusals based upon V-codes depicts a high

likelihood for the consequences

of these vaccine refusal behaviors now developing, with a clear peak

noted in the Pacific

Northwest.

http://www.measlesrubellainitiative.org/tag/japan/

Measles

Upon first glance, a disease like the measles appears mildly obtrusive, and not overly aggressive. So you decide to just lock the kid away in his or her room, in order to prevent others from making contact.

This is exactly what my parents did when I caught the measles in the early 1960s. (FYI: that is not me in this picture)

Then, my physician “Dr. D” came to our house, making “quarantine” less a problem back then than the same practice can be today.

Today, with both parents working and the need for a patient to be seen by his/her physician in the office setting, we set the stage for clusters of more cases to develop.

Which leads me to ask . . . if you were a parent sitting in the waiting room, and saw the child in this photo sitting across the room, what medical condition would you suspect he has?

How might we distinguish Measles from Hives? Or even Poison Ivy? Or an allergic reaction to soap or detergent? Or a photosensitivity to the last medication he was prescribed, or some over the counter product?

Would you consider this a risk to your own health? The health of your child (children?

Based on simple clinical observations, Measles, Chicken Pox or bothcould be infecting this patient. In fact, according to the source of this photograph (Top, 1947), both were infecting this child.

Chicken Pox

http://www.today.com/health/angelina-jolie-has-chickenpox-its-no-joke-1D80370180http://www.dailymail.co.uk/tvshowbiz/article-2872257/Angelina-Jolie-reveals-s-got-chicken-pox-won-t-able-attend-Unbroken-premiere.html?ito=social-facebook

https://www.facebook.com/DailyMail/posts/836142159778867

Thirty-nine year old Angelina Jolie came down with Chicken Pox in early December, 2014.

Chicken Pox cases are found across

the U.S. It is generally

perceived as a safe and natural

alternative to the recommended immunization

process.

The early sign of Chicken Pox is very “plain”,

and non-extraordinary.

“Tear Drop” vesicles form.

Chicken Pox, Day 2,

around a Small Pox

Vaccination Scar

On the second day we see more

vesicles and more of a reaction ensuing,

as well as new signs and

symptoms.

And like any “Natural Disease Process”, Chicken Pox does have its

complications . . .

A “normal”, but several looking Generalized, Polymorphic Eruption

Chicken Pox with bullous impetigo

Chicken pox with facial cellulitis, and a secondary lesions formed in

front of the ear.

and worse . . . .

Small Pox

A few days into a Small Pox infection, pustules begin merging together on adjacent parts of the body, forming a large crusty material that with time sloughs off. Pustules tend to aggregate the most on the face, head and appendages.

https://dittrickmuseumblog.files.wordpress.com/2014/06/image_3.jpg

Small Pox, at its worst

“Polysquamous secondary lesions” . . .

Treating Small Pox

FromInoculations to Vaccines

timelines.tv

From Benjamin Jesty, of Yetminster in Dorset, England, who inoculated his family with cowpox in 1774

Inoculation . . .

Before vaccinations, there were inoculations.

For inoculations, you took some material from the diseased part and exposed a previously uninfected person to it. The disease would then erupt. Sometimes a full fledged disease. Sometimes a simpler version of it. The goal of course was the latter.

Inoculations were part of the Revolutionary War soldier’s experience, and were required of nearly all troops starting in 1777 (in 1776, they were still uncertain).

As a result of infection, an inoculation forms and then naturally reduces, leaving the patient with a scar as evidence of the experience. In the Hudson valley of New York, inoculation was practiced up until about April 1803.

Source: Poughkeepsie Journal, Microfilm at Adriance Library, Poughkeepsie, NYThe replacement of inoculation with vaccines.

www.historyofvaccines.org

“Courtesy Wellcome Library, London.Francisco Javier de Balmis shows smallpox vaccination scars.”

. . . versus Vaccination

Map of de Balmis’s trips

The cowpox or kine pox was brought to the U.S. by Benjamin Waterhouse, of Harvard University, 1802.

Due to proximity, its first promoters in 1802/3, included a Quaker doctor and close friend of the Shakers residing in the Hudson Valley, and some New York and Philadelphia Medical School physicians.

See The Vaccination Inquirer and Health Review, Vol. 3 at https://books.google.com/books?id=xgUDAAAAYAAJ

Benjamin Waterhouse

Small Pox reaction,

reduced by Vaccinationrather than Inoculation.

[F.H. Top, 1947]

Vaccine Scar Fresh Vaccine

Telltale Signs

of your

history

MUMPS

Pittsburgh Penguins Captain Sidney CrosbyDecember 12, 2014

Kevin Allen and Nancy Armour, USA TODAY Sports. “ NHL mumps outbreak rare, but 'could happen anywhere‘ ”

Dec. 17, 2014.

Accessed at http://www.usatoday.com/story/sports/nhl/2014/12/17/nhl-mumps-outbreak-could-happen-anywhere/20562733/

The Mumps is produced by a viral infection of the parotid (salivary) gland.

http://www.immunize.org/photos/mumps-photos.asp FH Top, 1947

Those who had the mumps in the 1960s may remember this question from your family doctor:

‘Do you remember what side it was on?’*

It can spread from one side to the next, making it last for several weeks.

The mumps virus can enter the body and then impact kidneys, sexual organs, thyroid gland and pancreas. Cases infecting the nervous system can led to meningitis.

*I am not sure if the answer here really made much of a difference, like could it return if it infected just one side?

Long Term Side Effects of the Mumps

•Deafness

•Meningoencephalitis and complications•Seizures•Paralysis•Hydrocephaly . . .

http://www.cdc.gov/mumps/clinical/qa-disease.htmlhttp://www.livestrong.com/article/40876-longterm-side-effects-mumps/

SCARLET FEVER

wiki wiki

Streptococcus pyogenes

www.healthofchildren.com

http://www.tamworthinformed.co.uk/scarlet-fever-on-the-rise-in-midlands/

A Scarlet Fever patient’s presentation –Chief Signs and Symptoms

Stages for the “Strawberry Tongue” of Scarlet Fever

(Strep A)

The Ophthalmic Emergency: Orbital Abscess in Scarlet Fever

For more: http://www.patient.co.uk/doctor/orbital-and-preseptal-cellulitis

• Can lead to severe long term complications.

• Offers the streptococcus pathogen a more direct connection to the nervous system.

Complication 2

Nephritis (Kidney inflammation) with subsequent edema (kidney failure)

(also note swelling around the neck due to adenitis)

NonsuppurativeArthritis,

with a swollen left hand and

wrist(right side is not

impacted, and appears

normal)

Complication 3

The Consequences

of Acute

Mastoiditis and Nephritis,

associated with Scarlet Fever

Complication 4

Ethmoiditis

This child experienced infection of the

ethmoid sinus cavity by the streptococcus also responsible for

the scarlet fever.

Complication 5

Toxins produced by the organism can lead to renal failure and other organ system damage.

The continued growth of the organism throughout the body leads to the development of pustulence (pus), especially in the neck and tonsils area. This can be followed by abscessing.

Nearby tissues may then die and slough off, including blood vessels. This subsequent break down of blood vessels can result in severe hemorrhaging and untimely death.

This case demonstrates the results of the Schultz-Charlton Phenomenon or Blanching Test for diagnosis and treatment (note arrows on the belly). This result is produced by the application of an antitoxin for the Streptococcal pathogen on the skin.

See https://books.google.com/books?id=CQIWAQAAIAAJ&pg=RA1-PA15https://books.google.com/books?id=b7rtAAAAMAAJ&pg=PA62

Pityriasis rosea of the skin

Septic Scarlet Fever, with severe thrombosis and gangrenous nose

The streptococci responsible for Scarlet Fever may develop into a hemolytic form, which is assessed clinically by placing a tight (but not perfect) tourniquet on an appendage if it displays a significant scarlatina rash. This results in the formation of petechiae in just 10-20 minutes.

Also linked to the onset of a gangrenous state in Scarlet Fever patients:

Swelling of the Eyelids

Discharge of the Nose

Forchheimer Spots (red dots) on the soft palate

and tongue (the “strawberry tongue”)

See:http://www.cdc.gov/features/scarletfever/

DIPHTHERIA

1930s, Ohio http://flickrhivemind.net/Tags/diphtheria/Interesting

Pierre Bretonneau (1778-1862), coined the name diphtérite for this disease

In 1735, a major Diphtheria Epidemic spread across the Colonies in North America. This was one of the first epidemics to have corroborative evidence for the same event shared by several colonies.

http://dittrickmuseumblog.com/category/online-exhibits/

Examples of the Presentation of “Distemper”/Diphtheria to a Physician

More Modern Illustrations

This is the Pseudomembrane

or “False Membrane”, that is visible in the Throat of a

diphtheria patient. This sample is a near perfect

casting of the inner surface of the respiratory passages. It consists of waste material,

dead cells and debris left over by organisms growing within

the air passage.

An Important Diphtheria Lesson: Animals were/are very important to the development of vaccines.

Edward Jennings documented the value of kine poxvaccine as a preventive agent, due to the exposure ladies had while they were milking cows.

Whereas cows were the primary source for producing large amounts of vaccine for the pox, horses were preferred for diphtheria.

In 1811, Isaac I. Van Voorhis of Fishkill, NY, studied the use of horses to develop a better understanding of vaccines. He used much the same technique as Edward Jennings. After receiving his MD in 1812, he removed to Fort Dearborn, Chicago, where he served as a Surgeon. (He died in the Chicago Massacre one year later; and so, this story got lost.)http://history.amedd.army.mil/booksdocs/rev/gillett1/ch8.htmlhttp://wp.me/Puh6r-6u0

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Horses were the primary means for producing Diphtheria vaccines throughout the late 1800s.

Aside from Horses, Sheep were tried for the same purpose, and a few small businesses even tried producing vaccines using this method.

When vaccines were required of kids by law by the mid-19th century, this technique of manufacturing was essential for pharmaceutical industries to meet the growing demand.

In 1876, New York City became the first public health agency to establish a “Vaccine Farm” using cattle raised in Lakeview, New Jersey.

These vaccines required the lymph of a living animal and an antitoxin to lessen the reaction patients had to the vaccine itself. A specific ratio of the two was required for all products, and became the standard for defining potency and efficacy of a vaccine.

Whereas Cattle were the staple for producing pox vaccines, horses were

required to produce diphtheria vaccines.

Diphtheria, Croup, and PertussisIn contrast with Diphtheria, kids can also catch the Croup and Whooping Cough.

Bacterial croup in its worst form mimicked the diphtheria. Caused by Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis, it could produce symptoms ranging from laryngeal diphtheria, to bacterial tracheitis, to laryngotracheobronchitis, and to laryngotracheobronchopneumonitis.

Depicted here is a very early example of a vaporizer used to treat these cases (later made famous by Vick’s). Many early attempts to use this method for treating diphtheria were to no avail.

Whereas Croup and Whooping Cough did not completely close off air passages, diphtheria did. The laryngotomy process was used to treat countless diphtheria victims up until about 1885, when an intubation process was developed.

For the 1874 argument on this, in the Richmond and Lousiville Medical Jl, , go to: https://books.google.com/books?id=bXYCAAAAYAAJ&pg=PA354 From: medical-dictionary.thefreedictionary.com

Emergency Laryngotomy

In 1885, Joseph P. O'Dwyerinvented an intubation process that could be used to treat the obstruction of the larynx for a diphtheria patient.

By the early 1900s, this process, demonstrated in this photo, became an essential part of treating diphtheria patients to increase their survival rates.

A “Life-saver”: From Tracheotomy to Intubation

Other Lessons from the Past

Rotary International. . . on Pinterest

Brian Altonen . . . on Pinterest

National Institutes of Health

Lesson 1

Why immunize?

Lesson 2: What about Quarantine?• A public health, professional, and personal responsibility• Can people abide by this Public Health concept today? [recall recent Ebola incidents]

Cattle for Pox, 1880s-early 1900s (no longer practiced)

The entire body was shaved and sterilized. The skin was infected.

The pustules that formed had their lymph collected.

Animal aights activists currently are against the use of animals for

producing or testing medications and cosmetics. Ca. 1900

Pharmacognosy course text, Columbia University

Lesson 3: Respect our past . . . be grateful for new technology.

Lesson 4: Horses for Diphtheria

1898

Lesson 5: Once upon a time . . . Lymph + Antitoxin = Vaccine

This original Antitoxin-Lymph approach is of course no longer used

Lesson 6: The “Old” and “New” in vaccines, 19th to early 20th century

19th C20th C

21st C

Signs of change!

Recent History - Present Status

(On this poster are the years we initiated vaccines for . . . . )

Here is What we’ve Accomplished . . .

“the Vaccine Years”

The 1960s was a transitional period in the U.S. immunization program.

Much momentum was developed following the successful development of an oral polio vaccine, and according to this poster, the rapidly decreasing measles epidemic problem for the 1960s and early 1970s.

During the 1960s:Sabin’s Oral Poliovaccine was developedWe saw reductions in the number of Polio children Rubella pathogen was isolatedDTaP and MMR combos were being developedMeasles was the focus

Here is what has

happened:

Will we go back to: • the 90s • the 80s • the 70s • the 60s • Or earlier?

These recent

outbreaks,from

2012-15, are like

going back in time . . .

May 31, 1803 Poughkeepsie JournalSmall Pox Eradication

began about 1800(some argue

earlier)

It finally became

a Success in1980

Vaccine manufacturing ceased 1990

1984 & 2012 Hudson Valley, NY 2014

In recent years we’ve regressed, back to the 80’s perhaps.

Example

www.cdc.gov

http://www.cdc.gov/measles/cases-outbreaks.html

Most of the 2014 cases are

linked to the

Disneyland outbreak in California

The most recent

Measles outbreak confirms

this.

Signs of reverting back to . . .

• The 80s – Measles outbreaks, Mumps and Whooping Cough; numbers and events increase. [Current status? as of 1/2015]

• The 70s -- 2 or 3 of Measles, Whooping Cough, Mumps, with trace numbers of Rubella/Scarlet Fever, a Diphtheria “spike”.• Partial decreases (10%-25%) in DTaP and MMR combinations

• The 60s – 3 of 4 of Measles, Whooping Cough, Mumps, Tetanus, Hib, with spikes for Scarlet Fever/Diphtheria• Major decreases, esp. for DTaP and MMR combinations

• The 50s -- Measles, Whooping Cough, Mumps, and Tetanus; Scarlet Fever, Diphtheria, Hib; Polio especially a concern.

• The 40s – Scarlet Fever and Diphtheria are the indicators of severity; Polio is a major concern, if not already present.

theatlantic.com

www.huffingtonpost.com

healthymamas.com

National Institutes for Health

Vaccinate? The Sooner, the Better (but remain on schedule)

• The “Too Many Vaccines for my child” argument can be

eliminated through the use of new technology.

• But “Too many vaccines” is not the only excuse mothers use for not vaccinating their children.

• Today’s parents have no memories of experiencing measles or having a neighbor who child was disabled or deceased due to experiencing a disease “the way nature planned it.”

• This argument for avoiding vaccinations is based mostly on personal philosophy. Who wouldn’t regret learning he/she did not grow up to their fullest life potential due to vaccine their parents “missed” or ignored?

• Vaccines improve quality of life, and in the long run greatly reduce the cost for care we will need as we grow older.

The End