Jenner and Hippocrates: a Perspective on Vaccines for Small Pox Day

Bathroom Art at UNECOM featuring"Before the Shot", by Norman Rockwell

This print of a Norman Rockwell painting and the Hippocratic Oath hangs outside of my office door (okay, full disclosure, it is actually hanging in the bathroom outside my office door. I work in a quirky place). I love it; it is a constant reminder of the philosophy and mission of medical science. People tend to think of the Hippocratic Oath distilled into three words: "do no harm". As you see it is far more nuanced (not to mention lengthy). There is a great deal in these words about science, humility, and measured decision-making for the greater good of patients.

That's where Edward Jenner comes in. Today, May 14, 2015, marks 217 years since the first successful demonstration of protection against small pox by inoculation of a healthy person with a close relative, vaccinia (cow pox) virus. As you can guess, vaccinia virus is the source of the word "vaccine". The idea of immunity against disease was not new. Even though there was virtually no understanding of how our bodies achieved it, the realization that prior exposure protected against disease was well appreciated by the time Jenner did his work. In fact, Jenner was not even the first to notice that cow pox infection seemed to protect against small pox. He was, however, the first to do the experiment. He inoculated James Phipps, the young son of his gardener, with cow pox. Young James developed a fever, but recovered quickly. Jenner then deliberately infected him with small pox using a method called variolation. James did not develop the disease, then or in the rest of his life. Jenner repeated this experiment on 22 additional children, all of whom were protected. The use of cow pox to prevent small pox became the first routine vaccination, and the end result of this was the eradication of small pox in 1979. Jenner is often credited with having saved more lives than any other human being in history. Given the ease of transmission of small pox (i.e., it is unbelievably contagious) and its mortality rate, I don't doubt this claim in the least.

How would you see Jenner in 2015, in the context of the Hippocratic Oath? Would you have given him your son to test his theory on? Upon reading that question, I imagine your knee-jerk response might have been "GOD, no!!" But we have to remember the time that Jenner and James lived in. Perhaps a good analogy would be to imagine that you and your children currently live in Sierra Leone, and someone was offering to test their Ebola vaccine on your child. Suddenly the picture is not so clear. Is giving an experimental treatment that may cause harm better than leaving a patient vulnerable to something that undoubtedly would? Is it more ethical to chance the latter rather than push the former? I'm not certain that question has a clear answer. I don't know that I could have done to James what Jenner did; after all, I have a son not far in age from him and I can't imagine not thinking of my own boy while I tested an idea that could kill - or save - young James. But I am eternally grateful that Jenner could. Billions of lives have been saved, not just from small pox, but from the preventive medicine principle he demonstrated: vaccination.

Jenner was right, but what if he hadn't been? The Hippocratic Oath seemed so simple when you thought it was "I swear to do no harm", didn't it? The reality is much more complicated.

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