Review of the history of Vaccination and Inoculation, and the diseases that have been reduced due to the immunization program. An epidemiological transition approach is taken to evaluating the decline in the current preventive care system that exists for infections diseases. Asks the question--"Will Polio ever return?"

1. A History of [Un]Vaccinated Diseases
Brian Altonen MS MPH
1/27/2015

2. 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

3. 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.

4. Franklin Henry Top (1903 - )
Portrait source: ihm.nlm.nih.gov
For Biog: http://medicine.yale.edu/publications/Images/M@YV3I4.pdf

5. 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

6. More
examples
of
polio’s
impact,
from
recent
Web
News
pages

7. 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.

8. Poliomyelitis
The experience of Polio during the early 1950s
From the AMA Popular medical magazine: Hygieae

9. 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

10. 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)

11. Exercise had
to be a part of
the daily plan
for recovery as
part of every
muscle
re-education
process.
Hygieia (AMA)

12. 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)

13. Stretching and
movement
therapy
may be
performed to
prevent the
tightening and
reduced mobility
of joints,
ligaments and
tendons.
Hygieia (AMA)

14. “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 patients
By 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

15. 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

16. 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

17. June 1948
Hygieia
Magazine
(AMA)
Treating
the
patient as
a person
in a
typical
1948
“Polio
Center”

23. 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.

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

25. 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.

26. 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?

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

28. Chicken Pox
http://www.today.com/health/angelina-jolie-has-chickenpox-its-no-joke-1D80370180
http://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.

29. Chicken Pox cases
are found across
the U.S. It is
generally
perceived as a safe
and natural
alternative to the
recommended
immunization
process.

30. The early sign of
Chicken Pox is
very “plain”,
and non-
extraordinary.
“Tear Drop”
vesicles form.

31. 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.

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

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

34. Chicken Pox with bullous impetigo
Chicken pox with facial cellulitis,
and a secondary lesions formed in
front of the ear.

35. and worse . . . .

36. Small Pox

37. 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.

38. https://dittrickmuseumblog.files.wordpress.com/2014/06/image_3.jpg
Small Pox, at its worst

39. “Polysquamous secondary lesions” . . .

40. Treating
Small
Pox
From
Inoculations
to Vaccines

41. timelines.tv
From Benjamin Jesty, of Yetminster in Dorset, England, who inoculated his family
with cowpox in 1774
Inoculation . . .

42. 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.

43. www.historyofvaccines.org
“Courtesy Wellcome Library, London.
Francisco Javier de Balmis shows smallpox vaccination scars.”
. . . versus Vaccination
Map of de Balmis’s trips

44. 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

45. Small Pox
reaction,
reduced by
Vaccination
rather than
Inoculation.
[F.H. Top, 1947]

46. Vaccine Scar Fresh Vaccine
Telltale
Signs
of
your
history

47. MUMPS
Pittsburgh Penguins Captain Sidney Crosby
December 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/2014/1
2/17/nhl-mumps-outbreak-could-happen-
anywhere/20562733/

48. The Mumps is produced
by a viral infection of the
parotid (salivary) gland.
http://www.immunize.org/photos/mumps-photos.asp FH Top, 1947

49. 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?

50. Long Term Side Effects of the Mumps
•Deafness
•Meningoencephalitis and complications
•Seizures
•Paralysis
•Hydrocephaly . . .
http://www.cdc.gov/mumps/clinical/qa-disease.html
http://www.livestrong.com/article/40876-longterm-side-effects-mumps/

51. SCARLET FEVER
wiki wiki
Streptococcus pyogenes

52. 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

53. Stages for the “Strawberry
Tongue” of Scarlet Fever
(Strep A)

54. 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.

55. Complication 2
Nephritis (Kidney
inflammation) with
subsequent edema (kidney
failure)
(also note swelling around the
neck due to adenitis)

56. Nonsuppurative
Arthritis,
with a swollen
left hand and
wrist
(right side is not
impacted,
and appears
normal)
Complication 3

57. The
Consequences
of
Acute
Mastoiditis and
Nephritis,
associated with
Scarlet Fever
Complication 4

58. Ethmoiditis
This child experienced
infection of the
ethmoid sinus cavity
by the streptococcus
also responsible for
the scarlet fever.
Complication 5

59. 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.

60. 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-
PA15
https://books.google.com/books?id=b7rtAAAAMAAJ&pg=PA62
Pityriasis rosea of the skin

61. 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.

62. 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/

63. DIPHTHERIA
1930s, Ohio http://flickrhivemind.net/Tags/diphtheria/Interesting
Pierre Bretonneau (1778-1862), coined
the name diphtérite for this disease

64. 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.

65. http://dittrickmuseumblog.com/category/online-exhibits/
Examples of the Presentation of “Distemper”/Diphtheria to a Physician

66. More Modern Illustrations

67. 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.

68. An Important Diphtheria Lesson: Animals were/are
very important to the development of vaccines.
Edward Jennings documented the value of kine pox
vaccine 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
AforgottenpieceofAmericanMedicalhistory!!!

69. 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.

70. Diphtheria, Croup, and Pertussis
In 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.

71. 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

72. In 1885, Joseph P. O'Dwyer
invented 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

73. Other Lessons from the Past
Rotary International
. . . on Pinterest
Brian Altonen . . .
on Pinterest
National Institutes of Health

74. Lesson 1
Why immunize?

75. 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]

76. 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.

77. Lesson 4: Horses
for Diphtheria
1898

78. Lesson 5: Once upon a time . . .
Lymph + Antitoxin = Vaccine
This original Antitoxin-Lymph
approach is of course no longer used

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

80. 19th C
20th C
21st C
Signs of change!

81. Recent History - Present Status

82. (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.

83. During the 1960s:
Sabin’s Oral Poliovaccine was developed
We saw reductions in the number of Polio children
Rubella pathogen was isolated
DTaP and MMR combos were being developed
Measles was the focus
Here is
what has
happened:

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

85. These
recent
outbreaks,
from
2012-15,
are like
going back
in time . . .

86. May 31, 1803 Poughkeepsie JournalSmall Pox
Eradication
began
about 1800
(some argue
earlier)
It finally
became
a Success in
1980
Vaccine
manufacturing
ceased 1990

87. 1984 & 2012 Hudson Valley, NY 2014
In recent years we’ve regressed, back to the 80’s perhaps.
Example

88. 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.

89. 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

90. 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.

91. The End