Wednesday, August 03, 2005

Great Bastards in History

Edward Jenner 1749-1823
Do the ends justify the means? In 1979, the World Health Organization declared that smallpox had been eradicated. The death toll for the 20th Century alone had been estimated in the 100s of millions. Over the centuries, smallpox had decimated populations, and had left many more blind and/or scarred for life. So what can we say about the man who took the first steps towards the death of smallpox? Our cars should all have "What Would Jenner Do" bumper stickers, right? Edward Jenner was an English country doctor who participated in the practice, common at the time, of variolation. Old, dried fluid from the sores of smallpox patients would be used to vaccinate people in the hopes of preventing smallpox. The variolated patient would develop a mild form of smallpox (usually), survive the disease (usually), and thenceforward be immune to bad-ass smallpox (always). Variolation spelled trouble, however, since the freshly immunized patient could spread the disease to infants and the elderly -- basically, anyone with an imperfect immune system. And, as those 'usuallys' suggest, the process was not always benign. Being a country doc, Jenner knew of the widely held belief that women who milked cows were immune to smallpox. He reasoned that these women were developing cowpox, a similar but far less lethal disease, and that this gave them immunity to smallpox. He took this idea and ran with it. First he experimented on his own son, Edward Jr., using swinepox. Later he would focus on cowpox, and his subjects seemed primarily to consist of women and children. (There were a few men in the bunch, but this article suggests the preponderance of his subjects were children and paupered women.) His methods were always the same: he would vaccinate them cowpox, and later try repeatedly to infect them with smallpox. His theories were sound, his method saved lives, and now, most everyone regards him as a hero. Apologists like Dr. Tom Kerns bend over backwards to prove that Jenner's methods were ethically sound. But the guy experimented on children, and on women who were pregnant or nursing. This bothered the hell out of me when I first learned about it in medical school. It still bothers the hell out of me. I'll ask it again -- do the ends justify the means? If you want to torture yourself with that question, I can't think of a better case than Jenner's. Think about it: he probably put only a few dozen peoples' lives in danger. There are no recorded injuries or deaths from his studies. His work resulted in a far safer means of immunization, making life better for the millions of Europeans who adopted his method. But, did he do the right thing? D. PS: Bare Rump is still MIA in Hollywood, but her lover, Lord Valor, AKA Captain Argh, has updated us on his efforts to rescue her from the clutches of the Rabbit. And you thought I was all serious today ;o)


Blogger Jacob said...

It may not have been the best thing to experiment on children and pregnant/nursing women, but smallpox was a vicious killer and testing the weeker immune systems was a faster way to find a cure.

8/03/2005 10:18:00 PM  
Blogger Jona said...

This is a horribly tough question. But life then was a living nightmare (by our standards) and I think presented with watching one after another of my children dying in the many horrid ways of the time, I would have to answer yes if some could then survive without fear of the smallpox. Of course, I also have the luxury of knowing his work did produce fruit to help us all – and that makes a difference to my response…

I’m presently reading ‘1700 Scenes from London Life’ by Maureen Waller, it’s very good, and gives a detailed glimpse of the times – I haven’t reached the chapter on diseases yet, but I’ll let you know if (and how) it mentions his work.

8/04/2005 01:26:00 AM  
Blogger Douglas Hoffman said...

From a clinician's point of view, it becomes a question of informed consent. They probably didn't call it informed consent back then, but the basic principle is common sense. You don't do something to someone without letting them know, first, in language they can understand: what is it you're going to do; why you're going to do it; what are the alternatives; what are the risks. I haven't found any evidence in my reading that Jenner did any of that, and the fact he focused on poor women and children suggests to me he was trying to minimize his own personal risk if things went bad. But then, I'm a cynic.

8/04/2005 07:55:00 AM  
Anonymous Anonymous said...

Of course, back then these people were often the rich and powerful, so it may be that he didn't seek such consent from his lowly patients for the same reason that he probably didn't call his butler by his first name - they were below him - and not that he was that concerned about the repercussions.

For all his humanitarian concerns, he was the surgeon and they were the commoners.

I saw a documentary about a prominent surgeon who was also a showman - gave paid demonstrations of amputations and such like...

They were an odd lot back then...


8/04/2005 12:32:00 PM  
Anonymous Keith said...

Hey, I'm a name, not an anonymous...

keith :-)

8/04/2005 12:33:00 PM  
Blogger Gabriele C. said...

Keith, get a blog, then you won't be Anonymous any longer. :)

I have some books about those pioneers, the first attempts at using chloroforme, the invention of antisepsis, all that fun. And of course, Sauerbruch's autobiography. They were an odd lot back then indeed.

8/04/2005 04:11:00 PM  
Blogger Douglas Hoffman said...

I found one website which used the following logic to justify Jenner's actions: ethics have not fundamentally changed since the time of Plato; medical ethics must have been the same in Jenner's time; there was no public outcry over Jenner's experiments back then; therefore, he deserves a great big pat on the back.

Yup -- different times indeed.

Gabriele, if you can get Keith to start blogging, I'll give you a big virtual kiss.

8/04/2005 04:34:00 PM  
Blogger Jacob said...

Unfortunately I was in a hurry at the time I made my comment (see above) so I didn't get to write everything I wanted to write, so to add to my comment: Still, it's kind of jerkish to do what he did.

No virtual kissing or I'll be virtually vomiting. :)

8/04/2005 10:23:00 PM  
Anonymous PBW said...

Jenner is one of my personal heroes, so I'll cop to bias right off the bat. :)

It's hard to remember that less than 100 years ago in most of the world, the average horse or steer had more rights than women. In Jenner's time, men were viewed as valuable, important members of society. Women were breeders, chattels, and essentially property. Children had to survive the diseases of infancy and early childhood before they were regarded as having value (the exceptions being the sons of wealthy and/or titled fathers, who were generally pampered and cherished as the future landholders, leaders and so forth.)

If you can get into that mindset, Jenner experimenting on women and children was perfectly acceptable by the standards of his time.

We're not so lily-white, either. By our standards, in vitro fertilization for the purposes of stem cell harvesting and research is an acceptable measure for the benefits it promises. I often wonder what people in three hundred years will think of us for doing it.

8/04/2005 10:32:00 PM  
Anonymous keith said...

Never, I say, never, Gabriele! :-)

If I blogged, I wouldn't have time to wash, and then the wife would get annoyed.

Your virtual lips are safe from Doug's slobbering.

keith :-)

8/04/2005 11:09:00 PM  
Blogger Jacob said...

This comment has been removed by a blog administrator.

8/04/2005 11:22:00 PM  
Blogger Douglas Hoffman said...

PBW: Point taken. For me, it's an intellect vs. emotion problem. On an intellectual level, I understand that you can't judge the man by modern standards. On an emotional level, what he did still troubles me. I'd feel better about it if I knew he'd guinea pigged himself, but I've never seen any mention of this. (I suspect he was variolated as a child -- that would explain his immunity.)

Keith: kill joy!

8/04/2005 11:24:00 PM  

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