Armstrong – Table of Contents

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Smallpox Vaccination and Tetanus; Postvaccination Encephalitis


In the mid to late 1920s Charles Armstrong became involved in investigations (1-
6) that resulted in measures designed to eliminate tetanus as a potential complication
following vaccination against smallpox. He considered this achievement as one of the
significant contributions of his scientific career (7).
Smallpox, until it was declared eliminated worldwide by the United Nations
World Health Organization (WHO) in 1980 (8), was one of the pestilential scourges
known to antiquity. It would revisit communities at variable intervals causing widespread
epidemics with mortality of up to 30 per cent among its victims. Smallpox (scientific
name – variola), whose only known hosts are humans, spreads from person to person by
respiratory droplets and fomites. It produces a severe febrile illness with development of
a widespread pustular pox-like rash in which all the skin lesions are simultaneously in the
same stage of development. There is general organ involvement of the liver, kidney and
heart. Severe scarring from the healing rash occurs frequently. Some societies attempted
to prevent smallpox in susceptible populations by immunizing with live smallpox virus.
This procedure, known as “variolation”, was the administration of material from a
smallpox pustule into the skin of the recipient. Variolation usually resulted in a smallpox
illness that left the recipient immune to subsequent infection when re-exposed later to
patients with smallpox. Variolation also resulted in death and severe morbidity in a
variable number of vaccinees.
David McCullough (9), in his Pulitzer Prize-winning biography of John Adams,
described Abigail Adams’ taking the Adams children, household servants, and family

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