Iatrogenic concerns of the twentieth century: post-vaccinal encephalitis and spongiform encephalopathy.

Throughout the twentieth century, iatrogenic disease constituted an enduring problem in western medical discourse and practice. A survey of the medical literature, investigative reports, and archival material indicates that iatrogenic concerns persisted throughout the century. Two groups of case studies are presented: one associated with post-vaccinal encephalitis; the other, with the iatrogenically transmitted spongiform encephalopathies, scrapie and Creutzfeldt-Jakob disease. Kuru, a similar disease investigated in New Guinea--but which is thought to be neither iatrogenically caused nor transmitted--is also discussed to speculate on whether an iatrogenic lens might be a valuable tool with which to re-view its mode of transmission.

The smallpox vaccine and postvaccinal encephalitis.

Smallpox is one of the deadliest infectious diseases in history. The discovery by Edward Jenner that inoculation with a droplet of pus from a cow with cowpox protected a person from smallpox resulted in the successful vaccination of millions of people. There were, however, complications associated with smallpox vaccination; the most serious complication was postvaccinal encephalitis, which was reported to occur with an incidence of 1 in 110,000 vaccinations and a case-fatality rate of 50%. Before we become complacent with the idea that we will respond to a bioterrorism attack with a mass immunization program for smallpox, it is important to be reminded of the risk and clinical manifestations of postvaccinal encephalitis and the efficacy of antivaccinia gamma-globulin in preventing this complication. The first case of postvaccinal encephalitis as a complication of the Jennerian cowpox inoculation was observed in 1905. A century later, there is no effective therapy.