An item of trivia noted by another reviewer of Vaccine created an immediate interest in the subject addressed by Arthur Allen. Like many parents, I had a child whose favorite plaything at one time was an old Raggedy Ann doll. As described by Allen, Raggedy Ann originated as a rag doll created by New York City illustrator Johnny Gruelle, made for his daughter who became fatally ill following a smallpox vaccination. Indeed, Vaccine is filled with items for the trivia buff, ranging from the origin of the medical phrase “guinea pig” (George Bernard Shaw) to the method of delivering fresh smallpox vaccine to city residents“cattle drives” consisting of infected animals.

Allen begins his story with the history of the earliest use of inoculationthe term “vaccination” was not yet appliedin a widespread manner to immunize a population. Human civilization is ripe with epidemic disease, and smallpox certainly ranks among the most-feared diseases. Its reputation was deserved. Two forms of the disease have long been known: Variola major and a less virulent Variola minor. The molecular basis for the difference is still not understood, but those infected with the more virulent form, if they survivedand 20-30 percent did not during most outbreaksfrequently suffered lifelong scarring. Helplessness in facing a smallpox epidemic began to change in the early eighteenth century, the result in large part of observations on the part of Lady Mary Montagu, wife of the British ambassador to the Ottoman Empire. Herself once a victim of the disease, Lady Montagu became aware of the process of variolation, a medical procedure in which material from a drying pock was inoculated under the skin of a patient. When the procedure worked, the patient suffered only a mild illness but became immune to the disease. Sometimes the procedure failed, and the patient actually developed smallpox.

Variolation made its way to America, where in Boston two unlikely allies began the widespread use of the procedure: the Reverend Cotton Mather of Boston, who despite his deserved reputation as an intolerant minister, was surprisingly literate, even liberal, in the ways of science, and Zabdiel Boylston, a physician in the city. Overcoming opposition within the Church as well as the medical establishment of the day, the two men were instrumental in evolution of the idea that disease was not a punishment for sin but rather a challenge that could be overcome. Allen concludes this first section with the discovery and application by Edward Jenner, that material prepared from lesions of a similar disease, cowpox, was a safer measure than variolation for immunization against smallpox. The very word “vaccination” is a testament to the procedure, being derived from vacca, Latin for “cow.”

Even as the disease began to recede in the early twentieth century, the direct result of the widespread use of vaccination, controversies began to appear. Indeed, a significant portion of Vaccine deals with the arguments, pro and con, associated with vaccination against childhood disease in general. Some arguments were of course political: Should the state have the power to force vaccination on its citizenry? The author describes how in Philadelphia in 1903, patrol wagons carrying both physicians and police would suddenly appear at job sites, where mass inoculation of immigrant workers would take place. Even the first Raggedy Ann doll was made by the father of a child who died shortly after receiving forced inoculation at school. (The actual cause of death was unclear. Health authorities argued a heart defect was the reason.) Eventually the decision was made by the Supreme Court: The individual was indeed a free man and could not be forced to undergo vaccination on that basis. However, if public health was the factor at risk, the Court ruled that vaccination could be made compulsory.

The issue was more than political. Allen provides numerous examples of the tragic results from vaccine poorly made, of nonexistent quality control, and even contamination by bacteria of vaccine stocks. Controversies over vaccination represent a running theme throughout the book, and contamination, either inadvertent or through neglect, is a common factor. Many of the most tragic examples are associated with smallpox vaccination; it is no surprise that the antivaccine movement came to the forefront during these first years...

(The entire section is 1813 words.)