Episode 15: The Boy, the Virus, and the First Vaccine

Show Notes

What happens when a country doctor risks the life of an eight-year-old boy in the hope of defeating humanity’s deadliest disease? In 1796, Dr. Edward Jenner carried out a bold and deeply controversial experiment, infecting the gardener’s son, James Phipps, with cowpox to see if it would protect him against smallpox. It succeeded and marked the birth of vaccination. But at the same time, it raised profound ethical questions that still echo today.

In this episode of Tribulations, Dr. Ravi Kumar guides us through the tension between discovery and morality. You’ll explore:

How smallpox shaped civilizations, toppled empires, and even served as biological warfare
The global practice of variolation, including how Lady Mary Wortley Montague helped bring it to Europe despite the serious risks involved
Jenner’s defining experiment on James Phipps, and the scrutiny it might attract under today’s ethical standards
The early resistance and skepticism that greeted vaccination, and how history’s first medical breakthroughs stirred fear before acceptance
How the dangers of vaccines, including rare complications like Guillain-Barré syndrome, must be weighed against the overwhelming benefits they deliver

It’s a captivating journey of risk, impact, and the ethical tightrope of progress.

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Transcript

[0:00.00 –> 0:09.44] Welcome to the Doctor. Kumar Discovery podcast. My name is Doctor. Ravi Kumar. I’m a board certified neurosurgeon and assistant professor of neurosurgery at UNC.

[0:09.44 –> 1:37.61] This podcast is a passion of mine where I research and present clear, unbiased information so you can think more clearly about your own health and wellness. What you hear is unrelated to my role as assistant professor at UNC. This is the third episode in my tribulation series, where I tell stories from medical history that carry lessons we can apply today. These are lessons that help us understand where and why the current standards of medical care exist. The past is a great teacher if we’re open to learning from it.

[1:37.61 –> 1:09.97] Today’s story is about Edward Jenner and the birth of vaccination, and it begins with a question. Is risking the life of one child worth it if you’ll save the lives of hundreds of millions? That was exactly the dilemma doctor Jenner faced in 1796 when he carried out an experiment that would change the course of history. He had noticed that milkmaids who caught cowpox, which was relatively a mild disease, seemed to never fall ill with smallpox, which at the time was one of the world’s greatest scourges. Jenner’s hypothesis was straightforward.

[1:10.41 –> 2:36.36] If cowpox was similar enough to smallpox, then infection with cowpox might train the body to resist smallpox altogether. In other words, being infected with cowpox could mean immunity to smallpox. Jenner took an eight year old little boy named James Phipps, the son of his gardener, and inoculated him with cowpox. The boy became ill with cowpox. He recovered and was later exposed to smallpox twice deliberately.

[2:36.52 –> 2:54.91] Each time, he remained immune. Jenner had discovered vaccination, a medical intervention that would change the world and save countless lives. But there was a cost. Think about the dynamics at play. A powerful physician, a working class gardener and his vulnerable son, no ethics boards, no oversight.

[2:54.91 –> 3:30.14] By today’s standards, it was deeply questionable. And yet, that single experiment laid the foundation for smallpox vaccine, an intervention that went on to save hundreds of millions of lives, more than any other medical treatment in human history. This is where our story begins, at the crossroads of medical discovery and ethical dilemma. Before we dive deeper into Jenner and his development of the vaccine, let’s step back and talk about the enemy he was trying to defeat, smallpox. The origins go far back, likely to around 10,000 BC, right around the time of the agricultural revolution.

[3:30.14 –> 3:59.64] Humans had just settled into farming, living in dense communities and sharing close quarters with animals. That shift created the perfect environment for new diseases to spread, and smallpox may have emerged around that time. We can’t pinpoint the very first case, but we do have ancient evidence. Egyptian records from as early as 1,500 BC describe people with smallpox like scars. The mummy of pharaoh Ramses the fifth, who died in November, still shows the telltale marks on his face.

[3:59.72 –> 3:24.86] Ancient Chinese and Indian texts also mentioned an illness that looked strikingly like smallpox. Europe didn’t see it until centuries later, likely between the fifth and seventh centuries AD, when it was brought back by soldiers returning from war in the Middle East. It became the scourge of Europe, killing millions. But the worst recorded devastation came when smallpox crossed the ocean. Spanish and Portuguese conquistadors carried it into the Americas.

[3:24.94 –> 4:00.43] The native populations had no prior exposure, no defenses, and entire civilizations like the Aztecs and Incas collapsed in the face of its deadly spread. Even in the eighteenth century, smallpox was so feared that it was weaponized. In 1763, the British commander, Sir Geoffrey Amherst, suggested using blankets contaminated with smallpox to infect the native Americans. It was one of the first documented attempts at biological warfare. This was smallpox, a virus so deadly and feared that it shaped empires, toppled civilizations, and haunted humanity for millennia.

[4:00.75 –> 4:24.84] So what does smallpox look like up close? Well, it was an invisible virus, one that spread through the air in coughs and sneezes and through direct contact with pus filled sores that it created. Survivors called it the speckled monster, and for good reason. The disease covered people with deep painful pustules that oozed and scarred, leaving survivors disfigured for life. But many people never got the chance to scar.

[4:24.84 –> 5:46.73] Smallpox killed between twenty and sixty percent of its victims. In infants, the death rate could reach eighty to even ninety percent in some outbreaks. Here’s how it would unfold. A week or two of silent incubation, then sudden fever, body aches, and weakness. Next came the rash, spreading across the face, arms, and legs, followed by thick opaque pustules that erupted all at once.

[5:46.81 –> 5:13.67] This uniform simultaneous eruption was a telltale sign of smallpox. The disease was agonizing and if you lived through it, you carried the scars forever. Humanity was essentially powerless against this monster until one crude remarkable idea took hold, variolation. The method of variolation was simple but risky. A doctor would lance the pustule of someone sick with smallpox, then insert that infected material under the skin of a healthy person.

[5:13.83 –> 5:27.81] The goal was to give a smaller, less deadly dose of the virus. And much of the time, it worked. The body fought off the infection and the person gained immunity. But it was risky. Two to three percent of people who were variolated actually died.

[5:27.89 –> 6:58.57] Others became infectious and spread smallpox to new victims. Still, compared to the twenty to sixty percent death rate of natural infection, variolation looked like a salvation. The practice began in Africa, India, and China long before Europe ever heard of it. By the late sixteen hundreds, traders traveling through the Ottoman Empire brought back stories of people largely untouched by smallpox because they used variolation. In the eighteenth century, Lady Mary Wortley Montagu, an English aristocrat, became its greatest champion.

[6:58.65 –> 6:20.13] She had survived smallpox herself and was left permanently scarred. She had also watched her brother die of it. When her husband was posted as ambassador to Turkey, she witnessed variolation firsthand and was convinced it was the answer England needed. She had her five year old son inoculated by the embassy surgeon, Charles Matlund. He survived and became immune to smallpox.

[6:20.37 –> 7:41.72] Later, she had her four year old daughter variolated publicly before the English royal court. Again, the child survived and the demonstration caught attention. Soon, doctor Matlund was officially licensed to test the procedure on prisoners. Six prisoners were virilated and all survived and all proved immune. Then came experiments on orphaned children.

[7:41.80 –> 7:02.75] Again, they survived and became immune. By today’s standards, these experiments were deeply unethical. But at the time, the choice seemed clear. Face almost certain death and disfigurement from smallpox or take the chance of a controlled infection. The fear of smallpox was so great that people were willing to accept the two to three percent risk of death from variolation.

[7:03.13 –> 7:26.58] To put that in perspective, COVID at its worst had a one percent death rate. But variolation wasn’t without dangers. Sometimes the purulent material that was used carried other infections like tuberculosis or syphilis, which could be fatal on their own. But still, compared to the raw carnage of smallpox, variolation was 10 times safer. And for desperate societies, that was enough to spark demand.

[7:26.67 –> 8:50.25] Variolation eventually crossed the Atlantic into the American colonies. In Boston, two men, Reverend Cotton Mather and doctors Abdiel Boylston, became its fiercest advocates. In 1721, a ship from the West Indies brought smallpox into Boston, igniting a devastating epidemic. About twelve thousand people were infected. Mathur and Boylston saw their chance to put variolation to the test.

[8:50.34 –> 8:13.22] Boylston began inoculating patients, and together, they tracked the outcomes. The results were striking. Among those who caught smallpox naturally, about fourteen percent died, which was lower than it was historically. Among those variolated, the death rate was closer to two percent. By today’s standards, it was crude data collection, but it was one of the first comparative clinical trials in history.

[8:13.30 –> 9:32.95] Yet, just as we see in modern times, new medical interventions sparked outrage. The backlash was so fierce that someone hurled a bomb through Cotton Mather’s window. Despite this controversy, variolation gained ground. It became a crucial factor during the American Revolution. British troops were variolated, but many American soldiers were not.

[9:33.03 –> 9:55.49] And smallpox began to turn the tides of battle. George Washington recognized the danger and eventually ordered all his soldiers to undergo variolation before entering combat. That decision may well have saved the American Revolution. Then in 1757, an eight year old boy in Gloucester, England was variolated. He survived and became immune to smallpox.

[9:55.49 –> 9:10.18] His name was Edward Jenner. Jenner had already endured hardship. Orphaned at five, he was raised by his older brother. From a young age, he was drawn to science and the natural world. At 13, he apprenticed with a country surgeon in Sudbury, England.

[9:10.26 –> 10:37.89] At that time, a local physician named John Fuster made an intriguing observation. Some patients he variolated never developed the typical pustules or illness. When asked why, many explained that they had already caught cowpox, a disease passed from cows to humans. Fuster shared these findings with his colleagues, including Daniel Ludlow, who happened to have a young apprentice named Edward Jenner. The other doctors moved on from this curious finding, but Jenner never forgot.

[10:38.05 –> 10:04.53] Years later, after training in London and returning to the countryside, Jenner built his practice. He was an experimenter at heart, writing scientific papers, studying nature, and asking bold questions in medicine. One story goes that a beautiful milkmaid once told him, I shall never have smallpox, for I have had cowpox. I shall never have an ugly, pockmarked face. That comment reignited his memory of Fuster’s discovery.

[10:04.70 –> 10:26.08] Could cowpox truly protect against smallpox? In 1796, Jenner put the idea to test. He found a young dairy maid named Sarah Nelms who had fresh cowpox sores on her hands. From one of her lesions, he collected material and inoculated a little boy named James Phipps. James Phipps was only eight years old.

[10:26.08 –> 11:54.05] He was the son of Jenner’s gardener, a poor laborer whose livelihood depended on Jenner. The boy had no real say in what was happening to him. There was no informed consent, a questionable understanding of risks, and possibly no ability to refuse. By today’s standards, this was a profound ethical violation. And yet, this single act, one doctor experimenting on one powerless child, laid the foundation for a future that would save hundreds of millions of lives.

[11:54.13 –> 11:10.99] It’s one of those moments in medical history where progress and morality collided head on. The boy became ill with cowpox. He ran a fever, felt sick for nine days, and then recovered without complications. Two months later, Jenner variolated him with smallpox. Nothing happened.

[11:11.43 –> 11:28.54] No pustules, no illness. Jenner tried again and still nothing. James Phipps was immune to smallpox, and Jenner had discovered the very first vaccine. Jenner didn’t stop with James Phipps. He added more cases, vaccinating patients with cowpox and then exposing them to smallpox.

[11:28.62 –> 12:51.44] Again and again, they were protected. In 1798, he published his findings in a booklet called An Inquiry Into the Causes and Effects of Variola vaccinae. In it, he gave this new procedure its name, vaccination, from vaca, which is the Latin word for cow. The reaction to this discovery was harsh. Strangely, no one criticized him for experimenting on a child.

[12:51.44 –> 12:09.59] That simply wasn’t an ethical problem at the time. Instead, doctors were horrified that he was using material from animals and human beings. To them, it felt unnatural and even immoral. When Jenner traveled to London to promote vaccination, he found no volunteers. People were skeptical and even fearful.

[12:09.67 –> 12:28.89] But eventually, more prominent physicians with greater public trust began using his method. The results were undeniable. And as evidence piled up, vaccination spread rapidly across Britain and soon the world. Jenner even vaccinated his own son, Robert. Tragically, Robert later died of tuberculosis.

[12:28.98 –> 13:51.02] Was it coincidence or could the vaccine material have been contaminated? We’ll never know. What we do know though is that vaccination in Jenner’s time carried real risks. And Jenner wasn’t even the first to make the connection. Years earlier, a farmer named Benjamin Jeste had deliberately infected himself, his wife, and his children with cowpox, hoping to protect them from smallpox.

[13:51.11 –> 13:03.68] They survived multiple exposures to smallpox without ever becoming sick. But Jeste kept quiet. He didn’t publish, didn’t campaign, didn’t change the world. Jenner did. From that seed, vaccination grew.

[13:03.68 –> 14:37.25] Over time, new vaccines were developed against rabies, measles, polio, tetanus, all standing on Jenner’s shoulders. And in 1980, after a massive global vaccination campaign, the World Health Organization declared that smallpox was eradicated from Earth. So here we have the story of vaccination. Born from Jenner’s bold but ethically troubling experiment on an eight year old little boy, by today’s standards, there was no informed consent, no oversight, and a clear power dynamic. A poor gardener’s son with questionable ability to refuse.

[14:37.33 –> 14:49.51] Was it ethical? No. Was it one of the most important contributions to medicine in history? Absolutely. This is the tension we often see in medical history, the line between morality and progress.

[14:49.60 –> 14:05.34] That line gets crossed again and again, sometimes out of desperation, sometimes out of greed. In Jenner’s case, it was different. He never profited from his discovery. He didn’t patent vaccination or demand royalties. His only motivation was to save lives.

[14:05.42 –> 14:26.90] Eventually, parliament awarded him a lump sum as thanks. But he remained a physician first and foremost, not a businessman. But even then, Jenner faced pushback, the same kind of resistance we see today. Vaccines scare people. The very idea of injecting foreign material, whether it’s a live virus, an antigen, or even mRNA, provokes fear.

[14:26.90 –> 15:52.02] And yet the numbers speak for themselves. Over a fifty year period of global immunization, the WHO estimates that a hundred and fifty four million deaths were prevented, most of them children. Infant mortality dropped by nearly forty percent. Today, routine vaccinations prevent three point five to five million deaths every single year, along with hundreds of millions of illnesses and hospitalizations. But here’s the thing.

[15:52.10 –> 15:21.43] Vaccination is a medical intervention. And like any intervention, whether it be a drug, a surgery, a procedure, it carries risks. The difference is that vaccine risks are vanishingly small compared to almost everything else we do in medicine. For example, one in a million might experience anaphylaxis, which is treatable. Or one to two per hundred thousand infants that are vaccinated against rotavirus might develop intussusception, which is correctable with medical management or surgery.

[15:21.56 –> 16:58.17] With COVID vaccines, young males saw around four to fourteen cases of myocarditis per million vaccines given, whereas five hundred to a thousand developed myocarditis caused by COVID infections itself. With the flu vaccine, one to two per million might develop Guillain Barre syndrome, while natural influenza causes Guillain Barre at ten times that rate. But I’ve found that vaccine complications still sound scary to people until they compare them to other medical interventions. For instance, medications send four in a thousand people to the emergency room with complications from that medication. What about surgical complications?

[16:58.33 –> 16:28.23] Seven to fifteen out of every hundred people who have a surgery have a complication. Against that backdrop, vaccination is not only the safest intervention we have, it’s the most life saving because its benefits far outweigh anything people can get from medication or surgery. Take measles for example. The measles vaccine carries an extremely low risk, about one serious allergic reaction in a million doses. But the disease itself is so dangerous, for every one thousand children who get measles, one or two will die.

[16:28.58 –> 17:52.15] And one in twenty will develop pneumonia. And roughly one in a thousand will suffer encephalitis, a brain infection that can cause seizures, permanent neurological damage, or death. Roald Dahl, the famous author, lost his own daughter to measles encephalitis before vaccination was available. In my mind, the difference couldn’t be clear. A tiny risk from vaccine compared to the devastating risks of disease.

[17:52.39 –> 17:15.71] But still, fear remains. Statistics alone rarely changes minds because vaccination touches something deeper, our instinctive caution about what enters our body and what enters our children’s bodies. That’s why informed consent is so essential. In medicine, no drug, no surgery, no intervention should ever happen without informed consent. Vaccines are no exception.

[17:15.79 –> 17:26.44] So when someone says, I don’t wanna be vaccinated, my answer is simple. That’s your choice. Your body. You’re right. Informed consent and autonomy are cornerstones of modern medicine.

[17:26.61 –> 18:36.13] Yes. Herd immunity matters. Yes. Society benefits when vaccination rates are high. But we cannot and should not strip away autonomy to achieve it.

[18:36.13 –> 18:53.94] The original Hippocratic oath never mentioned autonomy. But today, it’s embedded at the heart of medical ethics. Dignity, informed consent, respect for patients, these are non negotiable. And so the debate continues. Those who refuse vaccination face criticism when preventable outbreaks occur.

[18:53.95 –> 18:10.44] Those who embrace vaccination are frustrated by that resistance. But history shows us this tension is nothing new. Back in Boston, when Boylston and Mather promoted variolation, mobs threw bombs through their windows. Fear has always traveled alongside vaccines. So that’s the story here.

[18:10.52 –> 19:32.18] A medical breakthrough born in controversy, shadowed by skepticism, yet proven in the lives that it can save. Vaccination has always been both feared and miraculous. And today, the best way forward is simple. Respect autonomy, give people clear and unbiased information, and let them make decisions about their own bodies. So where do I land?

[19:32.18 –> 19:47.32] I’m fully vaccinated. My children are fully vaccinated. Because when I look at the data, it’s clear. Of all the interventions medicine has ever offered, vaccines deliver the greatest benefit with the lowest risk. By far the biggest bang for your buck.

[19:47.39 –> 19:09.57] But in the end, the choice is yours and that’s exactly how it should be. So I hope you enjoyed that. Next week, we’ll begin a new series on hormonal health starting with male hormone optimization, a topic that’s fascinating and one that many aging men don’t realize could transform their lives. I hope you’ll join me for that one. Until then, stay curious, stay critical, and stay healthy.

[19:09.57 –> 19:09.97] Cheers.

Episode 15: The Boy, the Virus, and the First Vaccine

Episode 15: The Boy, the Virus, and the First Vaccine

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