February 28, 2011
Life, Liberty and the Pursuit of Vaccines
By HOWARD MARKEL, M.D.

Recently I found myself on the outskirts of an antivaccine rally in my hometown, listening to a succession of ill-informed diatribes with a mixture of dismay and fascination.

As a pediatrician, I was baffled by scientifically baseless attacks on the substances that have tamed smallpox, polio and a host of other deadly and disfiguring diseases, at least in the developed world.

But as a historian, I found it even more bewildering to hear speakers claim that government-sponsored vaccines were a violation of the founding fathers’ design.

It is true that in their time there was no such thing as safe, standardized immunization. But even then, inoculation was used to quell smallpox, the deadliest scourge of the day. Such preventive public health measures framed the early days of our nation as tightly as the “unalienable rights” of life, liberty and the pursuit of happiness.

John Adams was inoculated in 1764. Twelve years later, while he was in Philadelphia declaring American independence, his wife and children were inoculated as an epidemic raged in Boston. Gen. George Washington ordered his soldiers to be inoculated in 1777 because more men were falling to smallpox than to Redcoat muskets. Thomas Jefferson, who avidly followed the scientific literature on the subject, inoculated himself and his children in 1782.

But the most eloquent advocate of smallpox inoculation was Benjamin Franklin.

In 1721, the Puritan minister Cotton Mather promoted inoculation in partnership with a Boston physician named Zabdiel Boylston, who risked life and limb by inoculating his children, his black servants and many of his patients.

Among those opposing Mather’s efforts was Franklin’s brother James, the contrarian publisher of The New England Courant. Aside from the inherent danger of the procedure, James Franklin argued that religious zealots had no business practicing medicine. He was hardly alone; many colonists considered inoculation a breach of the Sixth Commandment (“Thou shalt not kill”).

Inoculation involved lancing open a wound and implanting dried scabs or fresh pus containing variola (the virus that causes smallpox) under the skin of a healthy, uninfected person. Said to have originated in China, it was commonly practiced across the Far East and the Ottoman Empire.

The procedure typically caused a milder form of smallpox and conferred lifelong immunity. Still, many people became ill from it, and not a few died. Moreover, it was feared that the inoculated would infect others.

Yet after an initial silence (perhaps out of fear of enraging his older brother), Benjamin Franklin became one of the colonies’ leading proponents of inoculation, trumpeting his advocacy in the pages of his own newspaper, The Pennsylvania Gazette.

Reporting on 72 Bostonians inoculated in March 1730, for example, he noted that only two died while “the rest have recovered perfect health.

“Of those who had it in the common way,” he continued, “ ’tis computed that one in four died.”

In the following decades Franklin compiled and published quantitative studies on inoculation’s value, working with several physicians at the Pennsylvania Hospital, an institution he helped found, and with the famed British clinician William Heberden. He was also concerned that the high cost of the procedure — more than many colonists’ annual income — made it inaccessible to the poorest Americans. In 1774, to counter this inequity, Franklin established the Society for Inoculating the Poor Gratis.

Haunting these activities was a very personal ghost: that of Francis Folger Franklin, the younger of his two sons.

Franky, as his parents called him, was born in 1732 — a golden child, his smiles brighter, his babblings more telling and his tricks more magical than all the other infants in the colonies combined. Benjamin advertised for a tutor when the boy was only 2.

When he died of smallpox at age 4, the Franklins were beyond condolence. His tombstone was inscribed, “The delight of all who knew him.”

Rumors abounded that Franky had died from an inoculation gone awry. The gossip led the grieving Franklin to declare that his son had never been inoculated because he was suffering from “flux,” or protracted diarrhea. Franklin insisted that Franky “receiv’d the distemper” — smallpox — “in the common way of infection,” and that “inoculation was a safe and beneficial practice.”

Inoculation was eventually replaced by the far safer method of vaccination, which uses a milder virus to induce immunity. An English country doctor named Edward Jenner made this discovery in 1796 after noting that local milkmaids who contracted the annoying but harmless cowpox infection on their hands remained healthy during lethal smallpox epidemics.

Jenner’s vaccination soon became the major means of preventing smallpox. In 1801 President Thomas Jefferson declared vaccination one of the nation’s first public health priorities. Two years later, he instructed Meriwether Lewis and William Clark to take vaccine on their expedition to the Pacific.

Franklin died in 1790 — six years before Jenner’s discovery and 190 years before the World Health Organization announced that vaccination efforts had succeeded in eradicating smallpox from the globe. Yet while composing the final portion of his “Autobiography” in 1788, Franklin reminded his readers about the importance of immunizing their children. His advice is especially useful today when so few Americans have firsthand knowledge of the panoply of once common killers now preventable thanks to safe, reliable vaccines.

“In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way,” he wrote. “I long regretted bitterly, and still regret that I had not given it to him by inoculation.

“This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way and that, therefore, the safer should be chosen.”

Dr. Howard Markel, a professor of the history of medicine at the University of Michigan, is the author of “An Anatomy of Addiction,” to be published in July.

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