The refusal of significant numbers of parents to vaccinate their children has created a sizable group of people needing very much to be studied, and has raised a number of important public health issues. Foremost among them is the fear that a large reservoir of unvaccinated persons could contribute to epidemic outbreaks that might involve vaccinated individuals as well. Equally pressing are the immediate practical questions of how best to protect the unvaccinated persons from disease, how to prevent such outbreaks if possible, and how to treat them effectively if they do occur. The long-term question which interests me the most is what the general health of this unvaccinated group will be like, and what we can deduce from this data concerning how vaccines really act.

I would like to begin by proposing that we use the terms vaccinated and unvaccinated instead of immunized and unimmunized, since the basis of the vaccination controversy is the belief of many parents that the vaccines do not produce a true immunity', but rather act in some other fashion--or, in my view, that they act immunosuppressively.

This may sound like a purely semantic distinction, but in fact it bears directly on the first question raised above. If the vaccines conferred a true immunity, as the natural illnesses do, then the unvaccinated people would pose a risk only to themselves. Children recovering from the measles or polio or whooping cough need never fear getting them again, no matter how often they are reexposed in the future. So, the reports of large-scale pertussis outbreaks in the United Kingdom since the vaccine was made optional seem to me a convincing argument against vaccinating anybody, even those who desire it, because if the vaccine produces authentic immunity, then this rebound phenomenon should not occur.

Furthermore, we should be skeptical about the "outbreaks" that are reported to have occurred. Pertussis, or "whooping cough," is actually rather difficult to diagnose conclusively, as it requires special cultures or antibody tests that many laboratories cannot perform and that many doctors, in the presence of suggestive symptoms, rarely take the trouble to order. Conversely, there are other cases of pertussis with typical signs and symptoms but negative cultures and no detectable antibodies. In other words, whooping cough as a clinical syndrome need not be associated with the organism Bordetella pertussis, against which the vaccine is prepared, or indeed with any microorganism whatsoever.

Reservoirs of people unvaccinated against measles, mumps, or diphtheria, on the other hand, should result in periodic outbreaks of these diseases. But again, authentic immunity, would insure that only the unvaccinated would fall ill, which has never proved to be the case. All known out breaks of these diseases in the post vaccine era have included large numbers of vaccinated people as well; an. in many instances a large majority of the cases had previously been vaccinated, some of them quite recently.

The argument that parents should vaccinate their children to protect society as a whole from epidemic does not make sense. Such epidemic argue rather against vaccinating the ones who were vaccinated but still came down with the disease as soon as they were exposed to it. Likewise, if we accept partial or temporary immunity--conceding that the vaccine are not that effective, but that we have no other alternative to these rebound epidemics--then are we not simply throwing good lives after bad, rather like acknowledging that our patients are addicted to dangerous drugs yet fearing to withdraw them or even withhold them from others, lest the original error be fully or frankly exposed?

Which brings us to the second question, namely, how to protect your unvaccinated child from an acute out break of one of these illnesses in the vicinity. The first priority is clearly to know the illness--its signs and symptoms, its natural history and vehicles of spread, its prevention and treatment.

Rather than reading this information from a pediatrics text and the passing it along to you, I suggest that you read up on these diseases. Even more importantly, meet with your local pediatrician or primary healthcare provider and plan a course of action. If you cannot immediately find someone whom you can work with or relate to, keep looking. Your local support system is too important to be left for the time when you need to call on it in a hurry.

Taking responsibility for not vaccinating is no different from taking responsibility for a homebirth or any other form of alternative health care. It calls for not a substitute for conventional care, but rather a different relationship to the healing process and the health-care system, based on personal choice and direct participation. We still need help when our children get sick, and we need to know that this help is available to us.

In the event of an outbreak, a great deal can be done to minimize the risk to those exposed and to treat those who actually fall ill--much of which does not involve chemical drugs or vaccines of questionable safety and effectiveness. The homeopathic method, one such approach, uses minute doses of natural substances to stimulate and enhance the natural defense mechanisms of the host. The homeopathic prevention and treatment of specific acute diseases are discussed in detail in the highly recommended book Homeopathy in Epidemic Diseases, by Dr. Dorothy Shepherd, a prominent English homeopath.'

The homeopathic approach to epidemic diseases in general was first employed by Hahnemann in 1799, during an extensive scarlet fever epidemic in the province of Saxony.2 After he had treated a dozen or so cases in the usual homeopathic fashion, giving small doses of remedies capable of producing similar illnesses experimentally, Hahnemann realized that one remedy helped to cure at least 75 percent of the cases, a second remedy covered another 15 percent or so, and the remaining 10 percent required a variety of different remedies corresponding to the unique features of each case. The principal remedy, which corresponded to the genus epidemicus (the main characteristics of the outbreak as a whole), was then given out prophylactically to people exposed to the disease, and also to patients in the early stages of illness--before the critical point, when other remedies would sometimes be needed, was reached.

The results were quite dramatic. Those so treated either did not get sick at all or suffered much milder illnesses, on the whole, than their compatriots who were not treated or who received the drugs and other heroic measures in standard practice at the time. Hahnemann became justly famous for this exploit; and since this time, his method has been used with equal or greater success throughout the world in treating numerous outbreaks of cholera, typhus, smallpox, yellow fever, influenza, and other acute diseases of similar type. Why it has not been more widely influential in this country is a great mystery, and clearly has to do with the historic decline of homeopathy as a thought form until the advent of the alternative health and self-care movement of the past 10 years or so.

The argument that parents should vaccinate their children to protect society as a whole from epidemics does not make sense.

Pertussis

"Whooping cough" can be quite a nasty and prolonged illness, even in older children, in whom it is seldom fatal or dangerous. It can certainly threaten life in young infants under one year of age, because of the narrowness of the immature laryngeal opening and its particular vulnerability to obstruction from any inflammation or swelling. It is rarely serious in children older than six; and adults, for some reason, rarely contract the illness at all, even when they are exposed and have never had it before.

The incubation period varies from one to two weeks; and the illness often begins quite slowly, with some fever, typical upper respiratory symptoms, and a cough that gradually becomes more and more paroxysmal, until the characteristic spasms appear, often terminating in vomiting or tenacious sputum ejected with great violence. Such a cough may commonly persist for six weeks or even longer, suggesting an autoallergic as well as an infectious origin.

The nosode Pertussin, prepared from the sputum of patients with this disease, is the homeopathic remedy generally used for prophylaxis of exposed children (Pertussin 30c, one dose daily for two weeks after contact); and it can also be given in early stages of illness, at four-hour intervals. Drosera is the remedy most often used for the illness itself, although other remedies may also be needed. For children with a well developed cough, Drosera 30c or Pertussin 30c may be given every four hours, or even more often if necessary. A physician should be consulted if the illness is severe.

Homeopathic remedies are available without prescription, but care should be exercised to obtain them from a manufacturer belonging to the American Association of Homeopathic Pharmacies. This way, you will know that they have been prepared in accordance with the standards of the U.S. Homeopathic Pharmacopoeia.

Diphtheria

Diphtheria is rarely seen today in developed countries, but small outbreaks have occurred in the southwestern U.S. (San Antonio in 1977). The illness is primarily a poisoning attributable to the toxin (a highly antigenic protein of high molecular weight) elaborated by the diphtheria bacillus. Diphtheria toxin is the source from which the standard vaccine is prepared (diphtheria "toxoid" is the toxin denatured by heat, alum precipitated? and preserved with an organomercury compound), and is also the source of the homeopathic remedy, or nosode, Diphtherinum, which is commonly used for prophylaxis and for treatment of complicated cases.

Diphtheria begins as a "cold" or sore throat after a very brief incubation period of two or three days. The primary infection is usually in the throat or nasopharynx, and quickly becomes apparent with a greyish, ulcerating "pseudomembrane," foul breath, high fever, and marked swelling of the cervical Iymph nodes (producing the classic "bull neck" in severe cases). Complications such as heart or kidney failure or esophageal obstruction may follow within a few days; and severe cases may be accompanied by difficulty in swallowing or talking, due to residual postdiphtheritic paralysis that may require further treatment. Diphtherinum 30c or 200c may be given in a daily dose for the first three days following exposure. A physician should be consulted and other remedies used if the illness develops.

Tetanus

Tetanus is essentially a wound infection complicated by inoculation of tetanus spores into the wound and germination of these under strict anaerobic conditions. The infection itself is relatively minor; like diphtheria (and its close relative botulism), tetanus is largely an intoxication produced by a highly antigenic protein, tetanus toxin, against which the standard vaccine is prepared by heat denaturation.

Tetanus does not occur epidemically, and cannot be passed from person to person, although conditions associated with wound infections (such as warfare) definitely favor it if the spores are present. The spore forming organisms live in horse manure, and to a lesser extent in human manure (chiefly among people who keep horses); but the spores themselves are highly weather-resistant and can survive in the soil for decades. They will germinate only under strict anaerobic conditions--such as a deep, jagged puncture wound with enough tissue damage to get the infection started (the proverbial "rusty nail") or a simple wound infection (a severe burn or an infected umbilical cord stump in a newborn) which consumes all the available oxygen and thereby allows the spores to germinate underneath.

Careful attention to wound hygiene will effectively eliminate the possibility of tetanus in the vast majority of puncture wounds. Wounds should be carefully inspected, thoroughly cleaned, surgically debrided of dead tissue (under local anesthesia, if necessary), and not allowed to close until healing is well under way "from below." Two homeopathic remedies that may have a useful role at this stage are Ledum 30c, which should be given every two to four hours from the time of the puncture, and Hypericum 30c, which should be substituted if any signs of infection are present.

I have had no experience with Tetanus, the remedy prepared from the toxin itself; and tetanus toxoid is of no value unless the individual has previously been vaccinated, since a primary antibody response takes at least 14 days, and the incubation period of the disease can be considerably shorter than this (three to 14 days). Hypericum can reputedly treat as well as prevent tetanus, but I would recommend giving human antitoxin at the first sign of the disease, since it is far less effective later on.

If you do decide to vaccinate your children with tetanus toxoid alone, there is no need to vaccinate until the child is old enough to walk around and navigate on his or her own (18 to 24 months), at which time the vaccine is far less likely to cause complications.

Poliomyelitis

The poliovirus produces no illness at all in over 90 percent of those exposed to it; among others, it causes, at most, an ordinary flu syndrome with fever, weakness, gastrointestinal symptoms, aches, and pains. Even in epidemic conditions, poliomyelitis (the severe central nervous system complication) develops only in relatively few anatomically susceptible persons, most of whom eventually recover.

The typical symptoms of poliomyelitis include extreme sensitivity to touch, irritability, stiff neck, and fine tremors in the early or preparalytic stage, which may look rather like a viral meningitis. Not infrequently, the fever will return to normal for a few days just prior to the onset of these central nervous system symptoms, at which time it will rise again, producing the "dromedary," or double-hump, fever chart. Paralysis--due to inflammation of the anterior horn cells, or motor nuclei of the spinal cord--often appears suddenly and early in the course of the illness, as complete loss of voluntary movement in a single limb, or perhaps of the palate and throat muscles (in the dangerous brain-stem or bulbar type), producing disturbances of swallowing. Most of these cases will still recover, with residual paralysis or death often supervening much later, after the acute inflammation has subsided.

The homeopathic remedy Lathyrus sativus has been found to correspond most closely in its symptomatology to central nervous system polio, and has been used with great effectiveness both for prophylaxis of exposed individuals and for treatment in the early stages of the illness, before irreversible damage has occurred. According to Dr. Shepherd, a Dr. Taylor Smith of Johannesburg used Lathyrus 30c, one dose every 16 days, in 82 healthy people (aged six months to 20 years) living in a seriously infected area, 12 of whom were direct contacts. This regimen was continued for the duration of the outbreak, and not one of these people developed poliomyelitis.

Dr. Smith also used Lathyrus 30c in three doses, 30 minutes apart, for a second group of 34 children who were ill with fever, neck rigidity, and muscle tenderness of varying severity. All of these children recovered promptly and completely, without any sequelae.

Dr. Grimmer of Chicago, a well known homeopath of the thirties and forties, recommended Latharus 30c or 200c in a single dose repeated every three weeks for the duration of the epidemic, and stated most emphatically, from his own experience, that paralysis will not develop in those so treated. Other remedies may be required for the illness itself, at the first sign of which a physician should, of course, be consulted.

Measles

Wild-type measles is a strong, febrile illness lasting at least one or two weeks, with a long incubation period of 14 to 21 days; a characteristically smooth, confluent rash; "measly" or runny catarrh of eyes and nose; and a sizable risk of further developments, such as pneumonia, otitis media, or even laryngitis of the croupy or whooping-cough type. The incidence of measles in susceptible contacts approaches 100 percent; and in populations not previously exposed to it, the fatality rate may be 20 percent or more. After generations of contact with European and North American cultures, it became a largely self-limited illness for these populations, one still memorable but producing complete recovery and a permanent or lifelong immunity in the vast majority of cases.

The prophylaxis and treatment of measles varies somewhat from outbreak to outbreak, the genus epidemicus corresponding most closely to Pulsatilla in Hahnemann's series, Bryonia in Dr. Shepherd's experience, and probably other remedies in other times and places. In the U.S., largely because of mass vaccination programs, acute measles is now predominantly a disease of adolescents and young adults, undoubtedly involving some genetic interaction with the vaccine virus; and it will probably call for still other remedies. Pulsatilla remains the remedy most often recommended for prophylaxis, although my own experience is still too limited to confirm or refute it.

Mumps

Mumps, or epidemic parotitis, resembles measles in its highly contagious nature and its predilection for the older age groups as a result of the vaccine program; but it is rather milder, as a rule. After an incubation period of three weeks, it begins with fever, runny nose, tenderness around the ears, and swelling of the parotid on one side, spreading to the other in a few days. About 25 percent of boys with mumps show swelling and inflammation of one or both testicles; in girls, the ovaries and breasts are occasionally affected. Residual scarring and atrophy of one testicle is sometimes seen in adolescent boys and young men.

The nosode Parotidinum, prepared from the saliva of an infected individual, may be used prophylactically, although Pilocarpine 6c is the remedy recommended by Shepherd for both prevention and treatment. I have had no personal experience using remedies with mumps.

Rubella

Rubella, or German measles, is the mildest of all the illnesses for which vaccines are presently required, and very often escapes detection entirely. In the adolescent and young adult populations--those presently most likely to develop it--the illness may be somewhat bothersome, with arthritic symptoms more likely; the same symptoms are often encountered after vaccination of these age groups. In children, there is no reason to treat rubella at all, in most cases. Pregnant women, especially those exposed in the first trimester, may be given Pulsatilla 6c or 30c every day for 14 days following exposure, or every four hours for fever and acute symptoms. Rubella should be suspected in the event of a mild fever; punctate rash; and swollen or tender lymph nodes behind the ears and neck, and around the base of the skull--an area seldom affected in other ailments.

People often ask if it is possible to "vaccinate" homeopathically, to use remedies for the same purpose that the vaccines are normally given. This question addresses not short-term prophylaxis in the event of an acute outbreak, which is discussed above, but routine, long-term protection of the entire population against these diseases.

There is some evidence that remedies can be used in this way. I know of several British veterinarians who use homeopathic rabies nosode in lieu of injections to protect their dogs--with no serious side effects and, as yet, no rabies. But in order to do so, they must give the remedy repeatedly throughout the life of the animal--an approach that would be much less suitable for humans. This brings us back to the concept of trying to permanently eliminate susceptibility to specific diseases. Why attempt such an uneconomical fantasy, as well as an unnecessary one, since the remedies work so splendidly well when illness is actually present or threatening?

People also ask whether or not homeopathic treatment can be used in conjunction with vaccines. Homeopathic remedies may be given to mitigate the effect or severity of vaccines, just as they have been used with good effect in cases of vaccine-related illness. Certainly, when vaccines are given, I would recommend giving Ledum 30c--the basic first-aid remedy for puncture wounds--immediately afterward, in three doses 30 minutes apart; and following it with either the nosode prepared from the disease or vaccine itself or Thuja 30c, the general "antidote" to all vaccines, in three doses 12 hours apart.

Be aware of the possibility that a strong family history of vaccine reaction may greatly increase the risk of receiving that particular vaccine. Any child whose brother or sister or parent reacted strongly or violently to a vaccine should certainly be excused from receiving it, preferably by obtaining a medical exemption from a physician practicing in that state. Likewise, any child whose sibling or parent previously contracted poliomyelitis, or a severe or complicated case of measles or whooping cough or any of the other diseases listed, should not receive the vaccine prepared against that illness. Other grounds for medical exemption include preexisting epilepsy, central nervous system disorder, or any severe or disabling chronic disease where the risk of serious exacerbation from the vaccine outweighs the more imponderable long-term benefit.

This brings us to the final question of the long-term impact of mass vaccination programs on individual and community health. Since I have expressed my concerns on this score, many people have asked if any research has been done to substantiate them. I can only appreciate the irony in the fact that the compulsory feature of these programs is precisely what makes it so conveniently impossible to study them--so much so, that parents refusing to vaccinate their children deserve to be congratulated for making such research possible, and should, in fact, be recruited when it is ready to be carried out.

Equally noteworthy is the unprecedented breadth and scope of the research that will be required. Nothing less than the total health picture of vaccinated and unvaccinated children, followed over an entire generation, will suffice--a great collective enterprise that not only will be exciting and important in itself, but surely will yield invaluable new models for holistic medical research generally, models that take us well beyond the outmoded focus on single "disease entities" in which we are still imprisoned today. So, regardless of whether or not you decide to vaccinate, I urge you all to think about a mechanism for how collaborative research of this kind can be conducted, and how each of us can play our part in it.

Notes

1. D. Shepherd, Homeopathy in Epidemic Diseases (Rustington, Essex [U.K.]: Health Sciences Press, 1967). Available from Homeopathic Educational Services, 2124 Kittredge St., Berkeley, CA 94704.

2. Samuel Hahnemann, MD (1755- 1843), the discoverer of homeopathy. .

3. R. Moskowitz, "The Case Against Immunizations,"Journal of the American Institute of Homeopathy 6 (7 March 1983). Available from the National Center for Homeopathy, 1500 Massachusetts Ave., NW, Washington, DC. Abridged version published in Mothering (Spring 1984). .

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Ricbard Moskowitz, MD was educated at Harvard (B.A.) and New York University (M.D.). After medical school he did 3 years of graduate study in Philosophy at the University of Colorado in Boulder on a U. S. Steel Fellowship.

He took his internship at St. Anthony's Hospital, Denver, and has been practicing family medicine since 1967, as well as attending about 800 home births. With a background in Oriental medicine and other forms of natural healing, Dr. Moskowitz studied homeopathy with George Vithoulkas in Greece and Rajan Sankaran and others in India.