(This post is out of sequence in my Memoir. However it is so apropos the current debate surrounding the lutes measles outbreak, I though it deserved to be published and re-blogged later)
Tetanus and Immunizations
Ancient folklore has it that there were four incurable conditions in medicine: scabies, rabies, babies, and tabes dorsalis.. We’ve come a long way since then.
There is a very troublesome organized campaign in the United States that targets parents in an attempt to convince them to stop vaccinating their children.
The information spread by these groups is misleading as well as seriously dangerous to the health of the nation as well as the rest of the world.
We are so fortunate to live in an era where certain bacterial and viral illnesses can be prevented by vaccination or immunization that we have forgotten how harmful these deadly organisms actually are. Physicians all too often do get to see cases of common illnesses such as hepatitis, but it is a real eye opener when a doctor has the non-privilege of seeing one of the rare ones. If the anti-vaccine groups had to participate in the care of any of the devastating consequences of vaccine preventable diseases, perhaps they would change their minds.
These insular minded advocates do not have to see liver failure following an infection with Hepatitis B.
They do not have to see the forty-year old school teacher die from congestive heart failure following the influenza attack that destroyed his cardiac muscle cells.
They do not have to see the congenital heart defect in the baby born to a mother who had Rubella during the pregnancy.
They did not have to manage Jim Henson’s case when he died of a pneumonia caused by the common and ordinary pneumococcal bacterium.
They have not seen the crippling effects of the few living individuals from pre-vaccine days that were fortunate enough not to die from polio but were nonetheless permanently crippled by it. Perhaps FDR doesn’t come to mind either.
The list goes on and on.
These advocacy groups always cite the rare case of the person who had a serious complication from a vaccination only to then utilize inductive reasoning which generates a hysterical perception in the general population that this vaccination is dangerous for everyone.
One of my favorite predictable gripes is the patient who comes to the office and states:
- So I got my flu shot and I got the flu anyway. What’s the point?
- Influenza is not the only virus that can give you a cold. When you were sick did you get tested for influenza?
- Then how do you know that it was the flu?
- I just know. So next year I’d rather just take the flu and skip the shot.
That’s when the little man in the front of my brain says:
- You really are a stupid ignoramus. Ask any of those 18 million souls who died in 1919 what they might think about a shot that could have saved their lives.
But the real words come out as:
- Why don’t we just discuss it again next year?
Anti-vaccination advocates also come up with ridiculous personal theories such as the one currently in vogue that the mercury (thimerosol) in the Mumps-Measles-Rubella (MMR) vaccine is responsible for childhood autism. This one is worse than simply fomenting generalized hysteria because the concept causes parents to shun vaccination schedules; generates litigation and is predicated entirely on false science. Based on real and credible CDC scientific evidence, this propaganda has been debunked only to become yet one more example of one of America’s new favorite pastimes: blame seeking.
False science is so seriously dangerous because it presents as fact a series of deductions made without true scientific proof. For example, the false science of racial genetics and characteristics perpetrated by Heinrich Himmler in the 1930s convinced the German people by a series of pseudo-scientific measurements and salacious proofs that Jews were an inferior race: Why? It’s because their skulls look different, of course.
The Aryan movement in modern America does the same thing reference to Afro-Americans: their brains are smaller.
Another recent example of medical false science was the inductive misinformation that silicone breast implants caused collagen vascular diseases; such as Lupus.
This resulted in multi-million dollar law suits, wasted court time and the temporary withdrawal of the product from the market; leaving some women who legitimately required this type of prosthesis for breast reconstruction with less desirable alternatives. It was all a colossal waste of time and money; but only in America. European countries paid it lip service and didn’t give the controversy the light of day.
But even in the case of the MMR vaccine, and despite more scientifically convincing evidence that autism probably has a genetic basis, as well as the fact that some autistic children are really mislabeled mentally retarded; being able to convince these ignorant stalwarts to the contrary is virtually impossible.
Or, as they say in Texas, do not let the truth ever interfere with a good story.
My eyes were opened for good after having to treat a case of Tetanus. Prior to seeing this disease in the flesh it was something a Resident House Officer would only read about and have to consider as part of a board review scenario.
This particular situation occurred in a middle aged white female woman who was doing window box gardening and happened to get a splinter in the web space between two fingers. It then got infected, resulting in a small pustule. But inside the little pustule the Clostridium bacteria had already set up shop and had done its dirty work before she came to the emergency room to have the abscess incised and the offending splinter removed.
Simple case, yes?
Not until she came back two days later complaining of hypersensitive skin and very non-specific neuralgic symptoms. If not for a very astute Infectious Disease Fellow she would have been sent home. But much to everyone’s surprise and veiled skepticism he had her admitted for observation. I said:
- So why did I get this case? There’s nothing wrong with her.
- Because I think she might have Tetanus
- Get out. That’s ridiculous. Nobody gets Tetanus anymore.
- Well she might have it
- Tell me why? This is nothing but dumping a shitty case on me.
- Well, my opinion is based on her history as well as the fact that she told me she was never vaccinated.
- So what history is that?
- A very recent foreign body infection followed by hyperirritability, acute skin sensitivity and the fact that her husband says when he touches her she starts to twitch, then yells at him and says: “Get away from me. Stop touching me.” That is coupled by the fact that they have a good relationship and he says she has never in her life ever talked to him like that.
- Yeah, right. Maybe it’s just change of life or something.
- Just admit her for observation; get Neurology over here; and every fifteen minutes or so just brush her skin with your fingertips. You’ll find out soon enough.
- What a drag.
After about two more hours of bedside testing I placed a frantic call to the I.D. resident and said:
- Get your ass over here right now. I just touched her and she went into a seizure.
- What did it look like?
- She screamed; arched up; clenched her fists; hyper-extended half her muscles and hyper flexed all the rest. The spasm was so intense I thought she was going to break her back.
- So I was right all along, yes? And when was the last time you saw a Grand mal seizure ever look like that?
- Never. So please, just get your ass over here right now because I have absolutely no idea what to do next.
She had Tetanus all right. But calling it Tetanus was euphemistic for what this horrific disease was really all about. Just blowing on her ear would cause so much involuntary total body muscle spasm I thought she would not only break her back, but would also beak every other bone in her body including her neck
And that was not to mention the horrifying screams that went before the spasms.
The treatment requires intubation, artificial ventilation and total body muscular paralysis with intravenous curare. The clinical conundrum here is that the disease then has to run its course over a period of several weeks, during which time other drugs are required in order to sedate the conscious brain. Because the patient is completely paralyzed there is then absolutely no way of knowing how awake the patients’ brain might be. Think about that one: you are completely paralyzed, unable to move or to communicate, yet your brain is aware of everything that is going on around you.
The case dragged on for three or four weeks, in the middle of which the patient developed pneumonia and then a bleeding ulcer requiring urgent surgical intervention. Unbelievably, she survived and after a period of intense physical therapy was able to walk out of the hospital. That case made a believer out of me, even to the point that despite the last Tetanus booster I had; which put me to bed for three days with worst “flu” like reaction I had ever experienced; I would still take the shot again over the deadly disease itself.
During the time I was at St. Luke’s there was actually one other case of Tetanus that had occurred in a heroin addict secondary to infected skin-popping abscesses. Fortunately, I did not get the case, which nonetheless had a curious footnote.
His “friends” were a collection of fairly unsavory fellow addicts who visited his bedside on a regular basis. One day however, the visitations suddenly stopped; but was curiously and coincidentally linked to the disappearance of several vials of curare that had been left in the patient’s cubicle. No one involved in the care was at all upset by the prospect of these junkies having gone out on the street and shot themselves up with something that would get them higher than they had ever been in their entire lives: all the way up to the level of the Pearly Gates.
The police would not even investigate a dead junkie with a needle still in his vein.
One really disturbing thing about vaccinations is the fact that the CDC has declared Smallpox to be eradicated from planet Earth; along with an opinion that vaccination for this virus is no longer necessary. This agency also believes that it owns the only remaining repository of the virus and that because it is hidden safely inside its freezer vaults, has even discussed the idea of destroying the remaining cultures.
If I ran the CDC, I would not be so cock sure about this.
We are living in the infancy of an era of genetic engineering that raises the possible specter of microbiologists having the potential ability to manufacture killer microbes earmarked for germ warfare.
A new global outbreak of Smallpox would have the potential to kill off ninety percent of the world’s non-immunized population, bringing new meaning to the aphoristic medieval curse that could possibly be adopted by a terrorist:
- May the Pox be upon you; your family; and all your family’s family.
We now have vaccines for the following diseases:
Smallpox, Polio, Measles, Mumps, Pertussis, Tetanus, German measles, meningococcal meningitis, pneumococcal pneumonia, Zoster, influenza, Hepatitis A and B, Anthrax, Yellow fever and genital HPV. In the very near future we may also have vaccines for Hepatitis C, the worst of the nasty triumvirate that includes A and B, as well as for HIV and Herpes.
When I was a child I developed mumps, measles, chicken pox and German measles. None of these diseases were pleasant. The Mumps was complicated by a mild case of cerebritis causing me to hallucinate about wild animals attacking our house.It’s only too bad I did not see the Virgin Mary in the back yard, instead of a Grizzly bear, or we might have been able to translate that vision into a fortune by selling the rain water that always seemed to cascade off the hill behind our house and filled up our basement. Lourdes in our cellar.
Perhaps the disease did leave me with a small degree of permanent brain damage that I can blame for my I.Q. being only slightly above average but not genius; just like the people who blame MMR for autism. But I was fortunate if the only complication I got from the mumps was to be attacked by an imaginary Grizzly bear, because sometimes these supposedly simple viruses can do a lot worse. And when they do kill, there is nothing at all imaginary about the death.
There was only one other case I ever encountered that highlights the fact that as science has become more sophisticated, some homeopathic theorists have paradoxically thrown us back to the Stone Ages.
A nurse I worked with, for holistic reasons, did not believe in tonsillectomies, and despite the fact that her daughter repeatedly developed Streptococcal pharyngitis, refused to let her have them removed.
Beta-streptococcus is known to be responsible for causing Rheumatic fever, a disease that eventually attacks and causes serious scarring to cardiac heart valves. Treating the infection with penicillin easily prevents this consequence.
So to make matters worse, after a number of prior infections and courses of antibiotics, this mother decided that too many antibiotic treatments could also be harmful. Instead of treating a subsequent Beta strep infection then, she had her daughter pray over lighted candles.
The outcome was predictable as the poor girl developed acute Rheumatic Fever, spent two weeks in the hospital; followed by permanent rheumatic scarring of her Mitral valve.
As far as I am concerned, this is a case of child abuse.
When I was a child I was fortunate that despite the fact of nay-sayers warning it could actually cause polio, my mother was proactive enough ignore them and pushed me to the head of the line for the Salk vaccine. Even people in the 1700’s were smart enough to know that if they rubbed their skin with exudate from someone else’s Small pox lesion; that they might get an attenuated or abbreviated form of the disease themselves.
At this point in my life, I remain a true believer, have received every vaccine available on the market and look forward to being the first in line to get the next one that comes out of pharmaceutical research and development.
These miracles of medical intervention prevent not only the serious common consequences of the diseases that they abort, but also save millions of lives.
To those nay sayers who still believe that vaccinations are passé, dangerous or unnecessary, I then facetiously say:
May the Pox never be upon you, your children, or your children’s children.
Soldier dying of Tetanus Painting by Sir Charles Bell