Thursday, June 26, 2014

Breaking news: Boston doctor does human subject research without IRB approval

Smallpox pustule gauge -- Edinburgh, Scotland, 1870-1930
Today's Massachusetts Moment from the Massachusetts Foundation for the Humanities relates a story from this day in 1721:

The English colonists tried to make the New World a haven from smallpox. Boston inspected all incoming ships; if one arrived with smallpox on board, it flew a quarantine flag and remained isolated until the disease had passed. People afflicted with smallpox were sent to stay — and often die — on Spectacle Island in Boston Harbor, safely distant from the city's population. However, even with these precautions, there was usually a smallpox outbreak every 12 years; each time, patients either survived and acquired immunity or they died.

An epidemic occurred "on schedule" in 1702 and then, for some unknown reason, not again in Boston for 19 years. As more and more children grew to maturity without being exposed to the pox, Bostonians knew that when the disease did return, it would be more devastating than ever before.

In the spring of 1721, a group of sailors brought smallpox with them when they came ashore in Boston. As soon as the first cases appeared, the town took dramatic measures to isolate the infected men, but it was too late. By May the city was in the grip of a virulent epidemic.

Cotton Mather
On this day in 1721, Boston doctor Zabdiel Boylston took a gamble with his young son's life and two of his slaves and inoculated them gainst smallpox. Puritan minister Cotton Mather had learned from one of his slaves that in Africa people did not fear the disease that so terrified Europeans. The Africans placed a small amount of smallpox pus into a scratch on children's arms, thus making them immune to the disease. When an epidemic broke out in Boston in 1721, Mather wanted to try this method. He convinced Dr. Boylston, but other physicians and the public thought the idea barbaric, even sinful. However, when those Boylston inoculated survived, the tide of public opinion began to turn. Within a few years, the once-controversial practice would be routine. 

Zabdiel Boylston
When news spread that Boylston's son and slaves had fully recovered, people began to defy the ban, seeking out the doctor to get inoculated. By the time the epidemic subsided, Zabdiel Boylston had inoculated 248 people. The procedure was grueling but 98% of his patients survived, compared to 85% of the non-inoculated.

Cotton Mather published the results. Swayed partly by Mather's report and partly by similarly successful experiments in England, in 1722 the British royal family chose to be inoculated — a decision that helped win acceptance for the practice. 

As noted by this article from the Boston Museum of Science:

Edward Jenner, an English country doctor and keen inoculator, later adapted the practice, developing a safer, more effective technique he called vaccination. Having noted that local people who caught cowpox gained immunity from the far more dangerous smallpox, he successfully induced such immunity in an experiment on a local boy, James Phipps, in 1796.

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